Table 3.
Healthcare Use and Patient Characteristics Among Patients With Established Hypertension in MarketScan Commercial Claims and Encounters, Medicare Supplement, and Medicaid Database, 2019
| Patient health care use and characteristics | Commercial |
Medicare supplement |
Medicaid |
|||
|---|---|---|---|---|---|---|
| SDOH-related Z code in 2019 = no | SDOH-related Z code in 2019 = yes | SDOH-related Z code in 2019 = no | SDOH-related Z code in 2019 = yes | SDOH-related Z code in 2019 = no | SDOH-related Z code in 2019 = yes | |
| n=1,019,531 | n=4,481 | n=295,207 | n=1,133 | n=141,918 | n=4,566 | |
| Medical costs and utilization of services, mean (SD) | ||||||
| Total medical net payments | $11,240.9 (34,260.7) | $20,834.0***(50,122.1) | $6,126.0 (18,679.0) | $10,883.5***(23,473.2) | $22,993.0 (36,416.0) | $37,014.7***(40,038.9) |
| Total inpatient net payments | $2,373.6 (19,425.3) | $6,012.6***(31,223.9) | $1,259.6 (9,826.2) | $3,015.1***(13,181.7) | $,3,118.1 (13,453.0) | $10,265.0***(22,963.2) |
| Total ED net payments | $511.3 (2,531.5) | $1,267.4***(3,964.5) | $163.8 (795.1) | $497.8***(1,894.3) | $977.9 (2,474.6) | $3,586.1***(7,900.1) |
| Total outpatient net payments | $4,783.6 (18,699.6) | $8,834.6***(26,422.2) | $2,788.9 (9,465.3) | $4,834.8***(9,567.6) | $11,260.7 (23,907.0) | $13,734.8***(21,657.0) |
| Total pharmacy net payments | $3,284.1 (13,211.3) | $4,155.4***(12,467.3) | $1,799.4 (8,793.5) | $2,377.6* (9,823.0) | $7,028.6 (17,914.8) | $8,434.3***(15,193.5) |
| Number of inpatient encounters | 0.1 (0.4) | 0.3***(0.8) | 0.2 (0.5) | 0.3***(0.7) | 0.3 (1.0) | 1.4***(2.7) |
| Number of ED encounters | 0.3 (0.9) | 0.8***(2.1) | 0.4 (1.1) | 1.1***(2.3) | 1.5 (3.4) | 5.7***(12.4) |
| Number of outpatient encounters | 13.2 (15.7) | 24.5***(21.6) | 23.3 (21.4) | 34.8***(26.7) | 58.8 (99.6) | 83.2***(103.9) |
| Number of pharmacy encounters | 25.3 (23.2) | 33.8***(28.1) | 32.5 (24.4) | 38.5***(28.4) | 67.6 (71.3) | 74.1***(66.7) |
| Dummy indicators of having any of the ICD-10-CM diagnosis of 17 conditions from the CCI in any setting, n (%) | ||||||
| Myocardial infarction | 15,841 (1.55%) | 110***(2.45%) | 12,009 (4.07%) | 65**(5.74%) | 7,387 (5.21%) | 406***(8.89%) |
| Congestive heart failure | 29,771 (2.92%) | 165**(3.68%) | 34,558 (11.71%) | 165**(14.56%) | 17,124 (12.07%) | 728***(15.94%) |
| Peripheral vascular disease | 38,320 (3.76%) | 201* (4.49%) | 58,813 (19.92%) | 242 (21.36%) | 14,800 (10.43%) | 558***(12.22%) |
| Cerebrovascular disease | 10,734 (1.05%) | 80***(1.79%) | 13,352 (4.52%) | 87***(7.68%) | 7,134 (5.03%) | 327***(7.16%) |
| Dementia | 856 (0.08%) | 16***(0.36%) | 11,504 (3.90%) | 121***(10.68%) | 3,275 (2.31%) | 116 (2.54%) |
| Chronic pulmonary disease | 113,871 (11.17%) | 752***(16.78%) | 57,375 (19.44%) | 279***(24.62%) | 44,971 (31.69%) | 2,055***(45.01%) |
| Rheumatic disease | 22,967 (2.25%) | 125* (2.79%) | 12,057 (4.08%) | 48 (4.24%) | 4,935 (3.48%) | 186* (4.07%) |
| Peptic ulcer disease | 6,376 (0.63%) | 48***(1.07%) | 3,331 (1.13%) | 17 (1.50%) | 2,103 (1.48%) | 99***(2.17%) |
| Mild liver disease | 51,892 (5.09%) | 341***(7.61%) | 14,247 (4.83%) | 74**(6.53%) | 12,226 (8.61%) | 704***(15.42%) |
| Diabetes without chronic complication | 249,189 (24.44%) | 1,138 (25.40%) | 88,833 (30.09%) | 332 (29.30%) | 48,686 (34.31%) | 1,869***(40.93%) |
| Diabetes with chronic complication | 68,861 (6.75%) | 363***(8.10%) | 44,336 (15.02%) | 185 (16.33%) | 23,622 (16.64%) | 971***(21.27%) |
| Hemiplegia or paraplegia | 3,187 (0.31%) | 34***(0.76%) | 2,621 (0.89%) | 17* (1.50%) | 4,746 (3.34%) | 198***(4.34%) |
| Renal disease | 42,342 (4.15%) | 186 (4.15%) | 43,749 (14.82%) | 182 (16.06%) | 13,928 (9.81%) | 538***(11.78%) |
| Any malignancy, including lymphoma and leukemia, except malignant neoplasm of skin | 49,323 (4.84%) | 247* (5.51%) | 46,310 (15.69%) | 183 (16.15%) | 6,637 (4.68%) | 257**(5.63%) |
| Moderate or severe liver disease | 2,084 (0.20%) | 22***(0.49%) | 786 (0.27%) | 3 (0.26%) | 1,200 (0.85%) | 78***(1.71%) |
| Metastatic solid tumor | 5,539 (0.54%) | 47***(1.05%) | 4,428 (1.50%) | 31***(2.74%) | 1,075 (0.76%) | 47* (1.03%) |
| AIDS/HIV | 3,739 (0.37%) | 25* (0.56%) | 280 (0.09%) | 1 (0.09%) | 2,790 (1.97%) | 184***(4.03%) |
| CCI score=0, n (%) | 566,646 (55.58%) | 2,218***(49.50%) | 88,841 (30.09%) | 291**(25.68%) | 48,914 (34.47%) | 914***(20.02%) |
| CCI score=1, n (%) | 243,129 (23.85%) | 1,127* (25.15%) | 62,321 (21.11%) | 233 (20.56%) | 30,136 (21.23%) | 1,024 (22.43%) |
| CCI score=2, n (%) | 89,916 (8.82%) | 458***(10.22%) | 46,571 (15.78%) | 182 (16.06%) | 18,356 (12.93%) | 710***(15.55%) |
| CCI score≥3, n (%) | 119,840 (11.75%) | 678***(15.13%) | 97,474 (33.02%) | 427***(37.69%) | 44,512 (31.36%) | 1,918***(42.01%) |
| CCI score, mean (SD) | 0.9 (1.5) | 1.1***(1.8) | 2.1 (2.3) | 2.4***(2.6) | 2.0 (2.4) | 2.8***(2.8) |
| Characteristics | ||||||
| Age at first dx, mean (SD) | 50.1 (8.0) | 48.5***(8.6) | 72.5 (7.2) | 73.8***(7.8) | 47.8 (11.4) | 47.4* (10.3) |
| Female, n (%) | 471,918 (46.29%) | 2,578***(57.53%) | 162,073 (54.90%) | 730***(64.43%) | 84,942 (59.85%) | 2,525***(55.30%) |
| Urban, n (%) | 856,167 (83.98%) | 3,840**(85.70%) | 253,257 (85.79%) | 959 (84.64%) | — | — |
| Northeast, n (%) | 227,865 (22.35%) | 956 (21.33%) | 141,507 (47.93%) | 453a (39.98%) | — | — |
| South, n (%) | 517,241 (50.73%) | 2,089***(46.62%) | 61,663 (20.89%) | 200**(17.65%) | — | — |
| Midwest, n (%) | 184,356 (18.08%) | 908***(20.26%) | 83,883 (28.41%) | 441***(38.92%) | — | — |
| West, n (%) | 88,056 (8.64%) | 520***(11.60%) | 8,007 (2.71%) | 39 (3.44%) | — | — |
| Non-Hispanic White, n (%) | — | — | — | — | 60,783 (42.83%) | 1,790***(39.20%) |
| Non-Hispanic Black, n (%) | — | — | — | — | 59,930 (42.23%) | 2,234***(48.93%) |
| Hispanic, n (%) | — | — | — | — | 2,603 (1.83%) | 58**(1.27%) |
| Other race, n (%) | — | — | — | — | 3,972 (2.80%) | 83***(1.82%) |
Note: p values were obtained from the Wilcoxon rank-sum test for continuous variables and Pearson's chi-square test for dummy indicators for comparisons between the presence of SDOH-related Z code versus not. Total medical net payments are the average of payments made by insurance plans in 2019. Total inpatient, ED, outpatient, and pharmacy payments are the average of the total inpatient, ED, outpatient, and pharmacy payments made by insurance plans in 2019. The number of inpatients, ED, outpatient, and pharmacy visits are the average numbers of inpatient, ED, outpatient, and pharmacy visits in 2019. The ICD-10-CM codes to identify the CCI dummy variables are in Appendix Table 3 (available online). All the dummy variables for the diseases were identified as equal one if at least 1 ICD-10-CM code of the respective ICD-10-CM was identified in any setting. Patients with established hypertension were defined if there were at least 1 inpatient, ED, or outpatient hypertension diagnosis (ICD-10-CM=I10–I15) from January 1, 2016 to December 31, 2017. Dash (–) indicates that data are not available in the respective databases. Boldface indicates statistical significance (*p<0.05; **p<0.01; ***p<0.001).
CCI, Charlson Comorbidity Index; ED, emergency department; SDOH, social determinant of health.