Abstract
BackgroundExcess weight is associated with poor health and increased healthcare costs. There are no reliable data describing the association between BMI and the use and costs of primary care services in the United Kingdom.MethodsAmong 69,440 participants in the Million Women Study with primary care records in the Clinical Practice Research Datalink between April 2006 (mean age 64 years) and March 2014, the annual rates and costs of their primary care consultations, prescription medications, and diagnostic and monitoring tests were estimated in relation to their self-reported body mass index (BMI) at recruitment in 1996–2001 (mean age 56 years). Associations of BMI with annual costs were projected to all women in England aged 55–79 years in 2013.ResultsOver an average follow-up of 6.0 years, annual rates and mean costs were lowest for women with a BMI of 20 to <22.5 kg/m2 for consultations (7.0 consultations, 99% CI 6.8–7.1; £288, £280–£295) and prescription medications (27.0 prescribed items, 26.0–27.9; £227, £216–£237). Above 20 kg/m2, a 2 kg/m2 higher BMI (a 5 kg change in weight for a woman of average height) was associated with 5.2% (4.8–5.6) and 9.9% (9.2–10.6) higher mean annual consultation and prescription medication costs, respectively. Annual rates and mean costs of diagnostic and monitoring tests were similar for women with different BMIs. Among all women aged 55–79 years in England, excess weight accounted for an estimated 11% (£229 million/£2.2 billion) of all consultation costs and 20% (£384 million/£1.9 billion) of all prescription medication costs, of which 27% were for diabetes drugs, 19% for circulatory system drugs, and 13% for analgesics.ConclusionsExcess body weight is associated with higher use and costs of primary care services among women in England. Reducing the prevalence of excess weight could improve the health of women and reduce pressures on primary care.
Highlights
These authors contributed : Borislava Mihaylova, Benjamin J CairnsCollaborators listed at the end of the manuscript
Using individual participant data from a large cohort of women in England linked to routinely collected primary care records, we describe and quantify the relationship between body mass index and the use and costs of primary care services
For women recruited in England, information was sought on death, emigration, and cancer registrations from National Health Service (NHS) Central Registers, hospital admissions from Hospital Episode Statistics, and primary care records from the Clinical Practice Research Datalink (CPRD)
Summary
Previous studies of primary healthcare services have generally been based on small-to-moderate numbers of participants, and are mostly from the United States (US), with no reliable evidence from the UK It is unclear how well these results translate to the UK given the large differences in medication prices [7], and the role of primary healthcare in the UK in determining access to most specialist care [8]. Using individual participant data from a large cohort of women in England linked to routinely collected primary care records, we describe and quantify the relationship between body mass index and the use and costs of primary care services. This provides insights into how much of the morbidity experienced by this group of women is potentially avoidable
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