Associations of recent weight loss with health care costs and utilization among older women.

John T Schousboe,Tien N Vo,Deborah M Kado,Howard A Fink,Brent C Taylor,Allyson M Kats,Kristine E Ensrud,Lisa Langsetmo

doi:10.1371/journal.pone.0191642

Abstract

The association of weight loss with health care costs among older women is uncertain. Our study aim was to examine the association of objectively measured weight change with subsequent total health care (THC) costs and other health care utilization among older women. Our study population included 2,083 women (mean age 80.2 years) enrolled in the Study of Osteoporotic Fractures and U.S. Medicare Fee for Service. Weight loss and gain were defined, respectively, as ≥5% decrease and ≥5% increase in body weight, and weight maintenance as <5% change in body weight over a period of 4.5 years. THC costs, outpatient costs, hospitalizations, and skilled nursing facility [SNF] utilization were estimated from Medicare claims for 1 year after the period during which weight change was measured. The associations of weight change with THC and outpatient costs were estimated using generalized linear models with gamma variance and log link functions, and with hospitalizations and SNF utilization using logistic models. Adjusted for age and current body mass index (BMI), weight loss compared with weight maintenance was associated with a 35% increase in THC costs ($2148 [95% CI, 745 to 3552], 2014 U.S. dollars), a 15% increase in outpatient costs ($329 [95% C.I. −1 to 660]), and odds ratios of 1.42 (95% CI, 1.14 to 1.76) for ≥1 hospital stay and 1.45 (95% CI, 1.03 to 2.03) for ≥1 SNF stay. These associations did not vary by BMI category. After additional adjustment for multi-morbidity and functional status, associations of weight loss with all four outcomes were no longer significant. In conclusion, ≥5% weight loss among older women is not associated with increased THC and outpatient costs, hospitalization, and SNF utilization, irrespective of BMI category after accounting for multi-morbidity and impaired functional status that accompany weight loss.

Highlights

Weight loss in older adults often is associated with incident morbidity and mortality, and may be associated with high health care utilization and costs. [1, 2] The relationship between weight loss and costs may be further modified by body mass index (BMI), since high BMI is associated with increased costs. [3, 4] A study using the Medicare Current Beneficiary Survey data found that weight loss among overweight and obese individuals was associated with increased health care costs among those age 65 to 74, but not among those age 75 and older, though this study was limited in that both BMI and weight-loss were self-reported
Grip strength, and self-rated health were not independently associated with total health care costs after full multivariable adjustment. In this population of community-dwelling women late in life, recent weight loss was associated with greater health care burden, characterized by higher total health care costs, hospital stays, Table 4
The association of weight loss with higher health care costs was consistent across BMI category

Summary

Introduction

Weight loss in older adults often is associated with incident morbidity and mortality, and may be associated with high health care utilization and costs. [1, 2] The relationship between weight loss and costs may be further modified by body mass index (BMI), since high BMI is associated with increased costs. [3, 4] A study using the Medicare Current Beneficiary Survey data found that weight loss among overweight and obese individuals was associated with increased health care costs among those age 65 to 74, but not among those age 75 and older, though this study was limited in that both BMI and weight-loss were self-reported. [5] No study has focused on the association of objectively measured weight change with health care costs among the very old (age 75 or older), and whether this association might differ by BMI. [5] No study has focused on the association of objectively measured weight change with health care costs among the very old (age 75 or older), and whether this association might differ by BMI. It is uncertain if an association of weight loss with health care utilization and costs is independent of multimorbidity burden and functional decline, Using data from the Study of Osteoporotic Fractures linked to Medicare claims among women who were enrolled in Fee for Service, our objective was three-fold; a) to estimate the association of recent weight loss with subsequent total health care costs (as a measure of aggregate health care burden), outpatient costs, hospital stays, and skilled nursing facility (SNF) stays; b) to determine if any association of weight loss with subsequent health care costs and utilization was explained by other characteristics that might be associated with weight loss, multi-morbidity burden, impaired functional status, or poor physical performance; and c) to examine if the association of weight loss with total health care costs varied by BMI category (normal, overweight, or obese)

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Conclusion