Trang Phan

Rachel Cox
MPH 646, Summer 2013
Coronary Heart Dieae an! Health Care "x#en!iture
Pro$ect "xecuti%e &ote'Scri#t
Slide 1: Introduction Trang
Hi e%eryone, thi #ro$ect (ill )e #reente! to you )y Trang an! Rachel*
+or our #ro$ect, (e ha%e !eci!e! to in%etigate the #otential relationhi# )et(een a coronary
heart !ieae !iagnoi an! health care ex#en!iture in 2010,
Slide 2: Introduction Trang
+irt, (e (ill #ro%i!e an o%er%ie( o- our reearch .uetion an! hy#othei,
Slide 3: Introduction Trang
/e !eigne! thi re#ort to in%etigate the relationhi# )et(een coronary heart !ieae !iagnoi
an! total health ex#en!iture in 2010, Due to the com#licate! nature o- coronary heart !ieae
0(hich (e (ill re-er to a CHD -or hort1, a!!itional -actor uch a age, high choleterol, high
)loo! #reure, an! mo2ing tatu (ill alo )e examine!, Thee %aria)le are ri2 -actor -or
CHD )ut (e alo ta2e into coni!eration that o)er%ation may ha%e thee con!ition (ithout a
CHD !iagnoi,
/e hy#othei3e that, on a%erage, in!i%i!ual (ith a coronary heart !ieae !iagnoi (ill
ex#erience an increae in total health ex#en!iture relati%e to in!i%i!ual (ithout uch a
!iagnoi,
Slide 5: Review of Literature Rachel
CHD i a !ieae in (hich #la.ue )uil! u# in the artie that u##ly )loo! to the heart,
4%er time, thi #la.ue can har!en, (hich re!uce the amount o- oxygen5rich )loo!
!eli%ere! to the heart, 6!!itionally, )loo! clot can -orm an! #otentially caue a heart
attac2,
Slide 6: Review of Literature Rachel
6n increae in the aging #o#ulation an! the #re%alence o- chronic !ieae are ex#ecte!
to increae the #ercentage o- the 7nite! State 8DP #ent on health care to 29: )y 203;,
CHD i aociate! (ith age an! )ecaue o- thi, health care cot relate! to CHD are
ex#ecte! to rie )y 41: o%er the next 30 year to o%er <1;; )illion,
Slide 7: Ga! in Literature Trang
6 (e con!ucte! our reearch, (e -oun! that current literature only examine the relationhi#
)et(een coronary heart !ieae an! the 7nite! State= total healthcare ex#en!iture, Ho(e%er, it
!oe not a!!re other -actor that may a--ect CHD !iagnoi,
4ur reearch (ill in%etigate ho( %aria)le uch a age, high choleterol !iagnoi, high )loo!
#reure !iagnoi, an! mo2ing tatu may in-luence CHD !iagnoi an! total health
ex#en!iture,
The literature alo !oe not a!!re in!i%i!ual cot o- CHD, >ntea!, it -ocue on o%erall
7nite! State healthcare ex#en!iture, Thi i a ga# that our reearch (ill attem#t to -ill in or!er
to account -or an in!i%i!ual= total healthcare ex#en!iture relati%e to CHD !iagnoi,
Slide ": #ata Source Trang
/e (ill no( go o%er the ource o- the !ata (e ue!,
Slide $: #ata Source% &'(S Trang
The Me!ical "x#en!iture Panel Sur%ey i a large cale ur%ey that inclu!e in-ormation -rom
-amilie, in!i%i!ual, me!ical #ro%i!er, an! em#loyer,
The to#ic o- thi ur%ey inclu!e utili3ation o- health er%ice, ty#e o- health er%ice,
-re.uency o- ue, cot, metho! o- #ayment, an! )rea!th o- health inurance,
4ur reearch ue! M"PS !ata -rom the year 2010,
Slide 1): #ata Source% *aria+le! , Rachel
Thi ta)le !i#lay all the %aria)le ue! in our analyi, >t inclu!e the original me# co!e, ho(
the %aria)le i meaure!, an! (hat the %aria)le (a rename! a-ter cleaning all the !ata,
Slide 11: #ata Source% *aria+le! Rachel
4ur !e#en!ent %aria)le i total health care ex#en!iture -or the year 2010,
?ecaue it #re%alence i riing an! it contitute a large amount o- 7S health care ex#en!iture,
(e choe coronary heart !ieae !iagnoi a out main ex#lanatory %aria)le,
7r a!!itional ex#lanatory %aria)le (ere choen )ecaue they igni-icantly a--ect the chance o-
coronary heart !ieae !iagnoi, Ho(e%er, they alo contri)ute to total health care ex#en!iture
i- a CHD !iagnoi i not #reent,
Slide 12: #ata Source% *aria+le! Rachel
7ing thee %aria)le allo( u to control -or -actor that may a--ect the relationhi# )et(een
CHD !iagnoi an! total health care ex#en!iture,
The %aria)le choen are@ age, high )loo! choleterol !iagnoi, high )loo! #reure !iagnoi,
an! mo2ing tatu,
Slide 13: #ata Source% Su--ar. Stati!tic! , Rachel
Here, ummary tatitic -or all o- our choen %aria)le are #reente!, +or each %aria)le, the
mean, tan!ar! !e%iation, min an! max are ho(n, /e can ee that the a%erage total ex#en!iture
acro all o)er%ation i a)out <4,243, The a%erage age i a)out 46 year ol!, 6!!itionally,
mot o)er%ation !o not ha%e any o- the ri2 -actor o-ten aociate! (ith CHD,
Slide 1/: &ethodological 0ra-ewor1 , Trang
Than2 you, Rachel, &o(, (e (ill go o%er our metho!ological -rame(or2 to ho( you ho(
(e analy3e! our !ata,
Slide 15: &ethodological 0ra-ewor1 , Trang
Pleae recall that the root mean .uare! error 0RMS" -or hort1 i a metho! that i ue! to
meaure the !i--erence )et(een the actual an! #re!icte! %alue o- the !e#en!ent %aria)le,
/ith that in min!, the or!inary leat .uare metho! i ue! to -in! (hich regreion line ma2e
the mallet RMS" error (hen #re!icting y -rom x, Thi metho! allo( u to -in! the line that
)et -it through all the #oint, Thi i the tatitical metho! that (e ue! to analy3e our !ata,
Slide 16: &ethodological 0ra-ewor1 , Trang
To !eign our regreion mo!el, (e et y A total health ex#en!iture an! x A coronary heart
!ieae !iagnoi,
6-ter a##lying the regreion mo!el e.uation, (e -oun! that (hen all ele i hel! e.ual, an
in!i%i!ual !iagnoe! (ith coronary heart !ieae ha! a #re!icte! total health ex#en!iture o-
<14,343 in 2010,
Slide 17: &ethodological 0ra-ewor1% Regre!!ion &odel Rachel
6-ter regreing CHD !iagnoi on total health care ex#en!iture, (e (ere a)le to !etermine )oth
the lo# an! interce#t to )e ue! in our regreion e.uation, The lo# i e.ual to a)out 10,;13
an! the interce#t i a)out 3,640,
Slide 1": &ethodological 0ra-ewor1% Regre!!ion '2uation , Rachel
7ing the regreion e.uation B A ? C ?x an! a##lying the lo# an! interce#t !etermine! -rom
regreion, (e (ere a)le to get a regreion e.uation o- y A 3,640 C 10,;13x, /e inter#ret thi
a@ all ele e.ual, o)er%ation (ithout a CHD !iagnoi ha!, on a%erage, a total health care
ex#en!iture o- <3,640 in the year 2010,
Slide 1$: &ethodological 0ra-ewor1% Grah Rachel
Thi image ho( the regreion o- CHD !iagnoi on total health care ex#en!iture, ?ecaue
CHD !iagnoi i )inary, the gra#h i %ery hetero2e!atic an! !oe not a##ear to !i#lay a
#oiti%e relationhi#, Ho(e%er, the -itte! line !oe ugget a #oiti%e aociation,
Slide 2): &ethodological 0ra-ewor1% &ultile Linear Regre!!ion Trang
/e alo ue! the multi#le linear regreion )ecaue there i li2ely more than one ex#lanatory
%aria)le that i aociate! (ith the !e#en!ent %aria)le, >ncor#orating a!!itional ex#lanatory
%aria)le can !ecreae )ia in our reult )y limiting the im#act o- con-oun!er,
?elo( i the mo!el e.uation that (e ue! to -rame our MDR
Slide 21: &ethodological 0ra-ewor1% &ultile Linear Regre!!ion Trang
Thi -igure !e#ict the regreion o- coronary heart !ieae !iagnoi, age, mo2ing tatu, high
)loo! #reure !iagnoi, an! high choleterol !iagnoi on total health ex#en!iture,
/e choe to ue a ro)ut tan!ar! error to account -or hetero2e!aticity an! the #reence o-
outlier in our !ataet,
Slide 22: Re!ult! Trang
&o( -or our reult*
Slide 23: Re!ult!% 3orrelation Trang
4ur !ata yiel!e! a correlation coe--icient o- 0,220, >n regar! to the ocial cience, thi r
%alue !emontrate a trong, #oiti%e relationhi# )et(een total health ex#en!iture an!
coronary heart !ieae !iagnoi,
The trong r %alue in!icate ho( cloely our !ata -it the linear regreion line 0-oot)all
ha#e1 )ut (e ha%e to )e cautiou )e-ore !eri%ing a caual relationhi# )et(een the t(o
%aria)le,
Slide 2/: Re!ult!% 4LS Regre!!ion Ta+le Trang
Thi i a ummary ta)le o- our 4DS regreion, >t inclu!e our ex#lanatory %aria)le,
coe--icient, ro)ut tan!ar! error, an! #5%alue,
Slide 25526: Re!ult!% Significance of 3oefficient! Rachel
Here, > (ill ex#lain the igni-icance o- the coe--icient -or each %aria)le a
!etermine! )y MDR,
36##7@ all ele e.ual, an in!i%i!ual (ith a CHD !iagnoi i ex#ecte! to hea%e,
on a%erage, a total health care ex#en!iture that i <;,3E2 greater than thoe (ithout
uch a !iagnoi, 6 #5%alue o- 0 lea! u to conclu!e that CHD !iagnoi i
igni-icant an!, (ith E9: con-i!ence, (e can ay that the true coe--icient i )et(een
6,141 an! F,634,
8ge@ all ele e.ual, -or e%ery year an in!i%i!ual= age increae, there i, on a%erage,
a <;9,90 increae in total health care ex#en!iture, 6 #5%alue o- 0 tell u that age i
igni-icant an! (e can ay, (ith E9: con-i!ence that the true coe--icient i )et(een
0,069 an! 0,0F6,
S-o1ing !tatu!@ all ele e.ual, an in!i%i!ual that mo2e i ex#ecte! to ha%e, on
a%erage, a total health care ex#en!iture that i <320 le than thoe (ho !o not
mo2e, Ho(e%er, the #5%alue o- 0,0;; ugget that thi %aria)le i not a igni-icant
-actor a--ecting total health care ex#en!iture,
6igh +lood re!!ure diagno!i!@ all ele e.ual, in!i%i!ual (ith a high )loo!
#reure !iagnoi can )e ex#ecte! to ha%e, on a%erage, a total health care
ex#en!iture that i <2,163 higher than thoe (ithout uch a !iagnoi, The #5%alue
o- 0 tell u that thi %aria)le i tatitically igni-icant an!, (ith E9: con-i!ence,
that the true coe--icient lie )et(een 1,;9 an! 2,9;0,
6igh chole!terol diagno!i!@ 6ll ele e.ual, in!i%i!ual (ith a )loo! choleterol
!iagnoi can )e ex#ecte! to ha%e, on a%erage, a total health care ex#en!iture that i
<1,214 higher than thoe (ithout uch a !iagnoi, The #5%alue o- 0 tell u that thi
i a igni-icant -actor in health care ex#en!iture an! (e can ay, (ith E9:
con-i!ence that the true coe--icient i )et(een 0,;F; an! 1,641,
Slide 27: Re!ult!% R
2
, Trang
The R
2
%alue re-lect the #ro#ortion o- total am#le %ariation in the !e#en!ent
%aria)le, ex#laine! )y the ex#lanatory %aria)le, /hen the R
2
%alue i cloer to 1,
the ex#lanatory %aria)le i more #re!icti%e o- the %ariation,
?ecaue our R
2
%alue A 0,0F;E an! i not cloe to 1, it ugget that our choen %aria)le are
not %ery #re!icti%e o- %ariation in health ex#en!iture, Thi in!icate that other -actor may
in-luence health ex#en!iture more than a CHD !iagnoi, age, mo2ing tatu, high )loo!
#reure !iagnoi, an! high choleterol !iagnoi,
Slide 2": Re!ult!% (redicted *alue! Rachel
Here, (e ue! our MDR e.uation, coe--icient, an! rele%ant %alue to #re!ict ex#ecte! %alue
-or total health care ex#en!iture, "xam#le 1 an! 2 com#are the a%erage #eron in the am#le
to the a%erage #eron (ith a CHD !iagnoi, The a%erage #eron i 446 year ol! (ith no
CHD !iagnoi an! no rele%ant ri2 -actor, 6 ex#ecte!, the in!i%i!ual (ith a CHD !iagnoi
i ex#ecte! to ha%e a total health care ex#en!iture that i a)out <;,3E2 higher, Similarly, a
#eron o- a%erage age (ith all the ri2 -actor an! a CHD !iagnoi i ex#ecte! to ha%e a total
health care ex#en!iture that i a)out <;,3E2 higher than an in!i%i!ual (ith all the ri2 -actor
)ut not CHD !iagnoi,
Slide 2$: Re!ult!% Suort of 6.othe!i! Trang
4ur -in!ing do u##ort our hy#othei that in!i%i!ual (ith a coronary heart !ieae !iagnoi
(ill ha%e higher total health ex#en!iture relati%e to thoe (ithout uch a !iagnoi,
The correlation coe--icient o- r A 0,220 in!icate that a trong, #oiti%e correlation exit
)et(een CHD !iagnoi an! total health ex#en!iture in 2010, Ho(e%er, our R
2
%alue A
0,0F;E (hich mean that only F,;E: o- the total %ariation in total health ex#en!iture can )e
ex#laine! )y our ex#lanatory %aria)le,
Thi ugget that -actor other than CHD !iagnoi an! it ri2 -actor in-luence total
health ex#en!iture to a greater !egree,
/e alo ha%e to remem)er that thi aociation !oe not im#ly cauation, There are li2ely to
)e more con-oun!ing -actor e%en though (e trie! to account -or them uing our a!!itional
ex#lanatory %aria)le, Some #otential con-oun!er (e ha%e not accounte! -or, (hich may
hea%ily im#act total health ex#en!iture, may )e comor)i!itie, ocioeconomic tatu, an!
location,
Slide 31: #i!cu!!ion Rachel
?ecaue CHD i more common in aging #o#ulation, -uture reearch houl! ta2e into account
co5mor)i!itie aociate! (ith age that may con-oun! the relationhi# )et(een CHD
!iagnoi an! total health care ex#en!iture, Some o- thee may )e cancer an! o)eity,
"!ucation, income, an! health inurance tatu may alo #lay a igni-icant role in total health
care ex#en!iture, Thoe (ith more e!ucation an! income are more li2ely to ha%e health
inurance an! ee their health #ro%i!er more regularly,
The reult o- thi in%etigation !o u##ort #re%iou reearch that -oun! age an! CHD
!iagnoi to )e aociate! (ith higher national health care ex#en!iture, ?ecaue no #re%iou
reearch ha! ex#lore! the relationhi# )et(een CHD !iagnoi an! in!i%i!ual ex#en!iture,
(e are gla! to ha%e -ille! thi reearch ga#, (hich (ill ho#e-ully im#ro%e a(arene o- the
!ieae an! it e--ect on !iagnoi #o#ulation,
4ur -in!ing can )e generali3e! to a (i!er #o#ulation an! ugget that (ith the increae!
cot o- a CHD !iagnoi, it i extremely im#ortant -or thee in!i%i!ual to ha%e acce to
a!e.uate health care, e#ecially lo( income #o#ulation, Policy meaure are nee!e! to ma2e
thi #oi)le, /ith the Me!iCai! ex#anion an! health inurance exchange im#lemente! )y
the 6--or!a)le Care 6ct, many more in!i%i!ual !iagnoe! (ith CHD (ill )e a)le to co%er
the increae! cot aociate! (ith their illne,
Slide 32: Reference! Trang
Than2 you -or litening to our #reentation to!ay* /e ho#e it (a hel#-ul an! in-ormati%e to
learn a)out the relationhi# )et(een coronary heart !ieae !iagnoi an! total health
ex#en!iture,