Unpacking Demographic Data Behind Health Care Costs in the US

Analyzing health care costs in the US by age, sex, race/ethnicity, and region, a Value in Health study highlights the factors driving expenditures and the need for targeted interventions to mitigate rising costs.

Health care costs in the US are recognized as unsustainable, with expenses increasing above economic growth. If trends continue, health care spending could reach 38% of the country's gross domestic product (GDP) by 2050. This financial burden impacts the economy and forces patients to forgo necessary care due to high costs. Efforts to address these issues have included reforming reimbursement structures and promoting value-based care, but the high costs persist. A study was conducted to estimate health care costs and identify patterns of expenditure by demographics to inform cost-minimizing interventions.

Health care costs in 2019 were analyzed using claims data from Optum’s Clinformatics Data Mart. Patients aged 18 and above with continuous health insurance from 2018 to 2019 were included in the study. Standardized costs were calculated for each patient based on pricing algorithms in the database. The results were analyzed using descriptive statistics and regression models to assess associations between patient characteristics and health care costs.

The analysis involved 9 227 901 adults, with the largest group being those aged 71 to 75 years, female, White, receiving care in the South, and having commercial health insurance. Age was positively related to health care costs, with females having 1.3 times higher costs compared to males. Health claims were most prevalent in the Northeast, followed by the Midwest, South, and West, with a small percentage having unknown geographic regions. Patients with severe renal failure, heart failure, or metastatic cancer had the highest yearly costs, with metastatic cancer and severe renal failure associated with significantly higher costs.

“We identified patient characteristics and medical conditions that are associated with high healthcare cost burden and could benefit from tailored interventions. We provided detailed cost estimates to aid healthcare modeling, cost projection, and cost-minimizing interventions,” researchers said. 

Reference
Adjei N N, Haas A, Sun C C, et al. Healthcare costs in the United States by demographic characteristics and comorbidity status. Value in Health. 2025;28(2):206-214. doi: 10.1016/j.jval.2024.10.3847.