Multidimensional sleep health and subsequent health-care costs and utilization in older women

Kristine E. Ensrud, Allyson M. Kats, John T. Schousboe, Lisa Langsetmo, Tien N. Vo, Terri L. Blackwell, Daniel J. Buysse, Sonia Ancoli-Israel, Katie L. Stone

Research output: Contribution to journalArticle

Abstract

STUDY OBJECTIVES: Determine the association of poor multidimensional sleep health with health-care costs and utilization. METHODS: We linked 1,459 community-dwelling women (mean age 83.6 years) participating in the Study of Osteoporotic Fractures Year 16 visit (2002-2004) with their Medicare claims. Five dimensions of sleep health (satisfaction, daytime sleepiness, timing, latency, and duration) were assessed by self-report. The number of impaired dimensions was expressed as a score (range 0-5). Total direct health-care costs and utilization were ascertained during the subsequent 36 months. RESULTS: Mean (SD) total health-care costs/year (2017 dollars) increased in a graded manner across the sleep health score ranging from $10,745 ($15,795) among women with no impairment to up to $15,332 ($22,810) in women with impairment in three to five dimensions (p = 0.01). After adjustment for age, race, and enrollment site, women with impairment in three to five dimensions vs. no impairment had greater mean total costs (cost ratio [CR] 1.34 [95% CI = 1.13 to 1.60]) and appeared to be at higher risk of hospitalization (odds ratio (OR) 1.31 [95% CI = 0.96 to 1.81]). After further accounting for number of medical conditions, functional limitations, and depressive symptoms, impairment in three to five sleep health dimensions was not associated with total costs (CR 1.02 [95% CI = 0.86 to 1.22]) or hospitalization (OR 0.91 [95% CI = 0.65 to 1.28]). Poor multidimensional sleep health was not related to outpatient costs or risk of skilled nursing facility stay. CONCLUSIONS: Older women with poor sleep health have higher subsequent total health-care costs largely attributable to their greater burden of medical conditions, functional limitations, and depressive symptoms.

Original languageEnglish (US)
JournalSleep
Volume43
Issue number2
DOIs
StatePublished - Feb 13 2020

    Fingerprint

Keywords

  • aging
  • health-care costs
  • health-care utilization
  • sleep health

PubMed: MeSH publication types

  • Journal Article

Cite this

Ensrud, K. E., Kats, A. M., Schousboe, J. T., Langsetmo, L., Vo, T. N., Blackwell, T. L., Buysse, D. J., Ancoli-Israel, S., & Stone, K. L. (2020). Multidimensional sleep health and subsequent health-care costs and utilization in older women. Sleep, 43(2). https://doi.org/10.1093/sleep/zsz230