Sex-associated healthcare expenditures related to cardiovascular risk factors in the community

Background/Introduction Cardiovascular risk factors (CVRFs) and their associated healthcare expenditures represent a major public health challenge in high-income countries. While the distribution of CVRFs and healthcare use differs between women and men, the association of CVRFs with healthcare expenditures across sexes remains unclear. Purpose We aimed to (1) examine the associations between traditional and non-traditional CVRFs and total healthcare expenditures, while controlling for other key determinants of healthcare expenditures, in the entire study population as well as separately for women and men; and (2) assess whether significant interactions between sex and CVRFs can be identified in the relationship between CVRFs and healthcare expenditures. Methods We used data from a Swiss population-based prospective cohort study that began in 2003, initially enrolling 6,733 participants aged 35–75 years at baseline with follow-ups every 4 years. For this analysis, we included participants from the third follow-up (2018-2021) who consented to share healthcare insurance data (N=1,441, mean age 63.0 years; 58% women). Sex-stratified two-part regression models were applied to examine healthcare expenditures, using a wide range of CVRFs as explanatory variables. Hence, we derived (1) the probability of incurring non-zero healthcare expenditures ("Probability" part as odds ratio (OR), 95% confidence interval (CI)) and (2) a multiplicative factor for the median level of expenditures among people with expenditures ("Level" part as cost ratio, 95% CI). We performed the analyses using two models: Model 1 included CVRFs as separate variables, and Model 2 incorporated the composite cardiovascular risk score (SCORE2(-OP)). Results Women reported less traditional CVRFs (e.g., smoking, hypertension) but more non-traditional CVRFs (e.g., sleep disorder, major depressive disorder (MDD)) than men. Median expenditures among people with expenditures were significantly higher in women (CHF 3,465.90 (interquartile range (IQR): 1,275.70–7,952.80) compared to men (CHF 2,461.30 (IQR: 404.40–6,467.10); p<0.001) (CHF 1 ≈ € 1). Overall, diabetes, higher cardiovascular risk according to the SCORE2(-OP) 2025 categories, obesity, sleep disorders, and MDD were associated with higher healthcare expenditures, while hypertension was uniquely associated with lower expenditures. Notably, in sex-stratified analyses, diabetes was associated with higher expenditures only in men, while sleep disorders, MDD, and categories of SCORE2(-OP) at higher risk were associated with higher expenditures in women only. Conclusions In this community-based cohort, CVRFs were differentially associated with healthcare expenditures in women and men. These findings incite to further explore sex-specific differences in cardiovascular prevention, especially in healthcare resource allocation strategies.