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ARS Home » Northeast Area » Boston, Massachusetts » Jean Mayer Human Nutrition Research Center On Aging » Research » Publications at this Location » Publication #409907
Research Project: Nutrition, Sarcopenia, Physical Function, and Skeletal Muscle Capacity During Aging

Location: Jean Mayer Human Nutrition Research Center On Aging

Title: Risk of mortality in older adults with loss of appetite: an analysis of Medicare fee-for-service data

Author
item DAGENAIS, SIMON - Pfizer, Inc
item CLARK, SUNDAY - Pfizer, Inc
item FIELDING, ROGER - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item CANTU, CERA - Clarify Health
item PRASAD, SAPNA - Clarify Health
item DAI, FENG - Pfizer, Inc
item GROARKE, JOHN - Pfizer, Inc

Submitted to: Journal of Nutrition Health and Aging
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/28/2023
Publication Date: 3/15/2024
Citation: Dagenais, S., Clark, S., Fielding, R.A., Cantu, C., Prasad, S., Dai, F., Groarke, J. 2024. Risk of mortality in older adults with loss of appetite: an analysis of Medicare fee-for-service data. Journal of Nutrition Health and Aging. https://doi.org/10.1016/j.jnha.2023.100035.
DOI: https://doi.org/10.1016/j.jnha.2023.100035

Interpretive Summary: In many cases, loss of appetite is not recognized in clinical settings when older adults are receiving healthcare. In this study, investigators examined the loss of appetite diagnosis using the Medicare database between 2015-2021. We found that individuals with loss of appetite had a significantly greater risk of death compared to those individuals without a loss of appetite diagnosis. This increased risk of death was maintained even when accounting for other health conditions associated with loss of appetite such as obesity, weight loss, cancer and cardiovascular disease. These results highlight the impact of appetite loss among older adults as an important health outcome related to nutritional status and survival.

Technical Abstract: Background: Prior research suggested that loss of appetite (LOA) among adults with Medicare fee-for-service (FFS) insurance in the United States increased the risk of mortality within one year. Those findings did not adjust for age, comorbidities, body mass index (BMI), and weight loss. Objective: To compare the risk of mortality among Medicare FFS beneficiaries with LOA versus those without LOA while controlling or adjusting for risk factors or potential confounders. Methods: Retrospective analysis of Medicare FFS claims data from October 1, 2015 to December 31, 2021, for beneficiaries aged 65-115 years with LOA (ICD-10 diagnosis code "R63.0 Anorexia") and a control group without LOA matched 1:3 on age, sex, and race/ethnicity. Mortality was compared using Kaplan-Meier and Cox regression analyses and stratified or adjusted in terms of Charlson Comorbidity Index (CCI), claims-based frailty index (CFI), BMI, and weight loss. Results: The study population of 1,707,031 individuals with LOA and 5,121,093 controls without LOA was 61.7% female and 82.2% White. More individuals with LOA compared with the control group had a CCI score 5+ (52.4% vs. 19.4%), CFI score 5+ (31.6% vs. 6.4%), and BMI <20 kg/m2 (11.2% vs. 2.1%). Median follow-up was 12 months (individuals with LOA) and 49 months (control group). In a matched population, the risk of mortality was significantly higher (unadjusted hazard ratio 4.40, 95% confidence interval 4.39-4.42) for individuals with LOA than the control group. Median survival time was 4 months (individuals with LOA) and 26 months (control group); differences in survival time remained when stratifying by CCI, BMI, and weight loss. Conclusion: Individuals with LOA had a substantially increased risk of death even after matching for age, sex, race/ethnicity, and adjusting for comorbidities. These findings highlight the burden of illness in older adults with LOA and the need for therapies.