# Healthcare Costs and Mortality Trends of Elderly ICU Patients: Evidence from an Eight-Year Cohort Study in China

## TL;DR

This study examines healthcare costs and mortality trends of elderly ICU patients in China over eight years, finding that while they have higher mortality, costs can be managed effectively with improved care efficiency.

## Contribution

The study provides novel insights into cost and mortality patterns of elderly ICU patients in China, highlighting improved efficiency in critical care over time.

## Key findings

- Elderly ICU patients had the highest mortality and longest ICU stays compared to younger groups.
- Surgical procedures significantly increased costs for elderly patients, while non-surgical costs were lower.
- Mortality among elderly ICU patients decreased over time without a rise in real costs, indicating improved care efficiency.

## Abstract

Background/Objectives: Elderly patients represent a growing proportion of ICU admissions, raising concerns about outcomes and healthcare costs. Evidence from China remains limited, yet understanding cost and mortality patterns is critical for optimizing care in aging populations. Methods: We retrospectively analyzed 31,535 ICU patients admitted from 2014 to 2021. After 1:1:1 matching on severity, comorbidities, sex, and admission type, three groups were formed: elderly (≥80 years), older (65–79 years), and younger (16–64 years), with 3398 patients each. Costs were inflation-adjusted, and outcomes compared across groups with appropriate statistical models. Results: Elderly patients accounted for 11.5% of admissions, had the longest ICU stay (4.5 vs. 3.8 vs. 3.1 days, p < 0.001), and the highest ICU (11.5%) and hospital (13.5%) mortality. Among non-surgical patients, elderly incurred the lowest costs; however, surgery reversed this pattern, producing a 124% increase. Expenditures were mainly driven by drugs and consumables. From 2014 to 2021, consumables rose from 32.0% to 42.0% of total costs, whereas drug costs declined. Inflation-adjusted hospital costs remained stable over time, while mortality among elderly patients decreased significantly (19.5% in 2014 vs. 8.8% in 2021; OR 0.86 per year, p < 0.001). Conclusions: Elderly ICU patients demonstrate unique cost and outcome profiles. While non-surgical elderly patients are less costly, surgery substantially increases expenses. Mortality declined over time without a rise in real costs, suggesting improved efficiency of critical care. These findings support tailored resource allocation and policy planning for aging ICU populations.