Prepared By: Amanda Briggs, Laura Jahen, & Audrey Lopez-Valdez

Introduction & Problem Statement

For this project, we utilized state-level mortality data from the Centers for Disease Control Prevention (CDC), as well as Medicare spending data from the Center for Medicare Services (CMS) and Kaiser Family Foundation. The focus of our analysis was on seniors aged 65 and older, and we specifically looked at mortality rates within this age group. The primary health conditions we analyzed were Diabetes, Hypertensive Disease, and Influenza and Pneumonia. Our data sets, which were sourced from multiple government and healthcare organizations, required significant aggregation and cleaning before they could be used for analysis. This cleaning process included re-coding invalid values, handling missing data, as well as standardizing categories to ensure consistency among the data sets. By preparing the data in this way, we were able to conduct statistical analysis and create visualizations that highlight key trends and relationships between mortality rates and healthcare expenditures. These findings are discussed in more details further down in our report.

Based on our analysis, our organization believes that we should increase funding to Medicare programs, particularly for our senior population. With this project, we set out to explore whether a correlation between mortality rates and health care expenditures in the United States existed. Based on the data we found, we recommend changes to public health policy, particularly around senior health and senior preventative health programs. Diabetes, hypertensive disease, and influenza and pneumonia are all diseases that can be minimized with proper preventative health which can be addressed with additional funding. Our organization especially emphasizes programming for diabetes and hypertensive disease because these are chronic conditions that will continue to drain funding if the conditions worsen.

Methods

The final results reported below are the product of three data sets that were cleaned and combined for analysis. The first contains state-level information on enrollment, utilization and spending for Medicare parts A and B. This dataset is from 2021 and provides insights into Medicare spending for individuals aged 65 and older across different states. This dataset provides critical information about Medicare enrollment and spending. The key actions necessary to clean this data are the combination of the spending Medicare A and B, as we are interested in total spending by the State, and ensuring the Total Spending variable is aligned with general knowledge of currency illustrations. The second data set is from the CDC and provides information from all 50 states in the year 2021 regarding the number of deaths by age group and underlying cause of death. This dataset helps inform us of the disease specific mortality rates and the disease specific death rates by state and age. This data was cleaned to focus specifically on individuals 65 and older who’s cause of death was recorded with specific ICD codes related to Diabetes, hypertensive disease, and influenza and pneumonia. The final data set is provisional mortality statistics by multiple cause of death provided by the CDC from all death certificates in the fifty states and DC. The dates included in this dataset are the years of 2018 to the present. This dataset was cleaned to reflect the population of interest and the specific time period of interest, 2021.

We combined all three datasets and created new variables including a mortality rate for each State. Then we created three visualizations to help illustrate potential associations between the reports data elements including, State and Medicare spending.

This visualization shows a scatterplot where each point represents a state, and the variables are the total deaths versus the medicare funding spent per enrollee. The points are very spread out, and do not show a linear relationship.
Mortality for Selected Causes and Medicare Spending by State in 2021
State Medicare Spending per Enrollee Population over 65 Total Deaths Mortality Rate
ALABAMA 10688 888817 3792 0.43
ALASKA 9939 97663 254 0.26
ARIZONA 10092 1333046 5295 0.40
ARKANSAS 9919 528101 2427 0.46
CALIFORNIA 12586 5957092 23452 0.39
COLORADO 9453 879653 2237 0.25
CONNECTICUT 12201 649235 1680 0.26
DELAWARE 11419 201646 568 0.28
DISTRICT OF COLUMBIA 11309 85838 397 0.46
FLORIDA 12170 4598386 15009 0.33
GEORGIA 10687 1584071 6459 0.41
HAWAII 7472 282304 800 0.28
IDAHO 8929 315456 1003 0.32
ILLINOIS 11283 2101462 6824 0.32
INDIANA 10757 1114688 4258 0.38
IOWA 9854 565273 2110 0.37
KANSAS 10533 489638 1954 0.40
KENTUCKY 10121 770260 2927 0.38
LOUISIANA 11650 761810 3102 0.41
MAINE 9159 297165 1113 0.37
MARYLAND 11899 1003157 3185 0.32
MASSACHUSETTS 11661 1214693 2993 0.25
MICHIGAN 10879 1822782 7179 0.39
MINNESOTA 11489 955683 2873 0.30
MISSISSIPPI 11428 494244 3155 0.64
MISSOURI 10477 1083767 3446 0.32
MONTANA 8649 216423 515 0.24
NEBRASKA 10670 321890 1254 0.39
NEVADA 11121 518467 2216 0.43
NEW HAMPSHIRE 9369 267521 643 0.24
NEW JERSEY 12394 1565917 4235 0.27
NEW MEXICO 8665 391946 1235 0.32
NEW YORK 13139 3477721 13206 0.38
NORTH CAROLINA 10106 1793314 6170 0.34
NORTH DAKOTA 11304 124641 436 0.35
OHIO 10630 2098999 8008 0.38
OKLAHOMA 11333 644711 5433 0.84
OREGON 8610 788379 2481 0.31
PENNSYLVANIA 10591 2464454 7656 0.31
RHODE ISLAND 9737 198791 577 0.29
SOUTH CAROLINA 10257 966399 3444 0.36
SOUTH DAKOTA 11399 156418 565 0.36
TENNESSEE 9889 1185272 5860 0.49
TEXAS 11964 3875984 14633 0.38
UTAH 9775 389148 1281 0.33
VERMONT 9206 133258 406 0.30
VIRGINIA 9475 1406652 4376 0.31
WASHINGTON 8737 1255178 4336 0.35
WEST VIRGINIA 10508 369420 1782 0.48
WISCONSIN 10212 1057243 3158 0.30
WYOMING 9975 103877 321 0.31

This table organizes our final data by State in the year 2021, and displays the total amount of funding spent on Medicare per enrollee in the State, the total population above 65 years, the total number of deaths, and the calculated mortality rate for that year. The mortality rate ranges from 0.238 in Montana to 0.843 in Oklahoma. You can also see in the table that spending per enrolle ranges from $7472 in Hawaii to $13,138 in New York. This bar chart highlights states with high mortality rates and low Medicare spending. North Carolina, Tennessee, and Arizona have particularly high mortality rates, exceeding 6,000 deaths per 100,000 population, while states like Wisconsin and South Carolina also exhibit concerning rates.

Discussion

The results from our analysis emphasize the need for increased public healthcare spending. Our analysis revealed variability in mortality rates and healthcare spending across the 50 states. Notably—Arizona, North Carolina, Missouri, Tennessee, South Carolina, Washington, Wisconsin, and Virginia—show a concerning trend of higher-than-average mortality rates along with lower Medicare spending per enrollee.

Diabetes and hypertensive disease were found to be key contributors to preventable deaths in the 65+ age group. These chronic conditions, along with infectious diseases like influenza and pneumonia, are often manageable or preventable with adequate access to preventive healthcare services.

Our analysis indicates that states with higher Medicare spending demonstrate lower mortality rates, highlighting the need for increased investment in healthcare so that it can lead to better health outcomes. For instance, states that allocate more funds to Medicare programs typically have more resources allocated to senior health initiatives. Conversely, states like those mentioned above may struggle to implement such programs effectively due to lack of funding.

These findings strongly support the recommendation to increase Medicare funding, particularly for states with high mortality and low spending. While our analysis provides valuable insights, limitations must be noted. The data is limited to 2021 and may not capture broader trends or the long-term effects of healthcare spending. Additionally, our analysis does not account for other determinants of health, such as socioeconomic factors or access to private healthcare. Further research can address these gaps to provide a more comprehensive understanding of the interplay between healthcare spending and mortality rates.