Mortality causes and health spending by gender and health conditions in octogenarians, nonagenarians and centenarians in Colombia

Oscar Espinosa; Valeria Bejarano; Isabella Franky; Sandeep Pagali; Michael Drummond; Oscar H Franco

doi:10.1038/s41598-024-84150-4

Mortality causes and health spending by gender and health conditions in octogenarians, nonagenarians and centenarians in Colombia

Sci Rep. 2025 Jan 6;15(1):918. doi: 10.1038/s41598-024-84150-4.

Authors

Oscar Espinosa¹, Valeria Bejarano², Isabella Franky², Sandeep Pagali³, Michael Drummond⁴, Oscar H Franco⁵

Affiliations

¹ Economic Models and Quantitative Methods Research Group, Centro de Investigaciones para el Desarrollo, Universidad Nacional de Colombia, Bogotá, D.C., Colombia. oaespinosaa@unal.edu.co.
² Economic Models and Quantitative Methods Research Group, Centro de Investigaciones para el Desarrollo, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
³ Division of Hospital Medicine & Section of Geriatrics, Department of Medicine, Mayo Clinic, Rochester, USA.
⁴ Centre for Health Economics, University of York, York, UK.
⁵ School of Public Health, University Medical Center Utrecht, Utrecht University & Harvard T.H. Chan, Harvard University, Utrecht, The Netherlands.

Abstract

This document determines the causes of mortality (2008-2022) and calculate per capita health expenditure (2013-2021) in octogenarians, nonagenarians and centenarians in the Colombian population, considering year, gender and age group. For this nationwide retrospective descriptive observational study, epidemiological regions, urban/rural areas and morbidities were also studied. A mean of 75,552 deaths was observed from 2008 to 2022. Deaths were higher due to ischemic heart disease, COVID-19, chronic obstructive pulmonary disease, cancer, and cerebrovascular diseases in the oldest old Colombian population with urban areas having higher mortality rates than rural areas (an average of 948 (min: 847, max: 1207) against 630 (min: 558, max: 789) per 10,000 people, respectively). Conditions of cerebrovascular diseases, cancer, influenza pneumonia and chronic obstructive pulmonary disease were the most expensive in health care, summing above 5000 purchasing power parity USD on average (min: 2234, max: 7539). These conditions, along with hypertension and diabetes mellitus, were the most frequently recorded. COVID-19 incurred higher health expenditure in rural areas compared to urban areas (1090 vs. 519 purchasing power parity USD respectively). High prevalence (14·3%) and medical attention (16·8 health care utilisations per capita) were shown for organic mental disorders. Our analysis found that centenarians survived COVID-19 more than octogenarians and nonagenarians, with several hypotheses attributing this to their immune profiles. We found high expenditure on HIV/AIDS among older males suggesting the need for further study on sexually transmitted diseases prevention in this population. Lastly, Alzheimer's disease, particularly in rural areas, had substantial expenditure. Therefore, neurodegenerative diseases and the impact of stressful events on mental health must be priorities for the health system to ensure adequate resource management.

Keywords: Centenarians; Colombia; Health care spending; Longevity; Mortality; Nonagenarians; Octogenarians.

Publication types

Observational Study

MeSH terms

Aged, 80 and over
COVID-19* / economics
COVID-19* / epidemiology
COVID-19* / mortality
Cause of Death
Colombia / epidemiology
Female
Health Expenditures* / statistics & numerical data
Humans
Male
Retrospective Studies
Rural Population
SARS-CoV-2 / isolation & purification
Sex Factors