Abstract
SummaryBackgroundExcess weight is associated with poor health and increased health-care costs. However, a detailed understanding of the effects of excess weight on total hospital costs and costs for different health conditions is needed.MethodsWomen in England aged 50–64 years were recruited into the prospective Million Women Study cohort in 1996–2001 through 60 NHS breast cancer screening centres. Participants were followed up and annual hospital costs and admission rates were estimated for April 1, 2006, to March 31, 2011, in relation to body-mass index (BMI) at recruitment, overall and for categories of health conditions defined by the International Classification of Diseases 10th revision chapter of the primary diagnosis at admission. Associations of BMI with hospital costs were projected to the 2013 population of women aged 55–79 years in England.Findings1 093 866 women who provided information on height and weight, had a BMI of at least 18·5 kg/m2, and had no previous cancer at recruitment, were followed up for an average of 4·9 years from April 1, 2006 (12·3 years from recruitment), during which time 1·84 million hospital admissions were recorded. Annual hospital costs were lowest for women with a BMI of 20·0 kg/m2 to less than 22·5 kg/m2 (£567 per woman per year, 99% CI 556–577). Every 2 kg/m2 increase in BMI above 20 kg/m2 was associated with a 7·4% (7·1–7·6) increase in annual hospital costs. Excess weight was associated with increased costs for all diagnostic categories, except respiratory conditions and fractures. £662 million (14·6%) of the estimated £4·5 billion of total annual hospital costs among all women aged 55–79 years in England was attributed to excess weight (BMI ≥25 kg/m2), of which £517 million (78%) arose from hospital admissions with procedures. £258 million (39%) of the costs attributed to excess weight were due to musculoskeletal admissions, mainly for knee replacement surgeries.InterpretationExcess body weight is associated with increased hospital costs for middle-aged and older women in England across a broad range of conditions, especially knee replacement surgery and diabetes. These results provide reliable up-to-date estimates of the health-care costs of excess weight and emphasise the need for investment to tackle this public health issue.FundingCancer Research UK; Medical Research Council; National Institute for Health Research.
Highlights
The prevalence of overweight and obesity has increased substantially in most countries in recent decades, and more than 60% of adult men and women in the UK are overweight or obese.[1]
Evidence before this study We searched MEDLINE and Embase using terms related to economics and costs, and overweight and obesity, for studies published in English between Jan 1, 1990, and Sept 19, 2016, which investigated the association between overweight or obesity, or both, and direct health-care costs
Of the 1 198 393 women recruited into the Million Women Study in England with follow-up for inpatient and day-case care beyond March 31, 2006, we excluded 34 708 (3%) with a previous cancer registration, 59 514 (5%) with missing information on weight or height, or both, and 10 305 (1%) who were underw eight (BMI
Summary
The prevalence of overweight and obesity has increased substantially in most countries in recent decades, and more than 60% of adult men and women in the UK are overweight or obese.[1]. Hospital care is the largest single component of healthcare expenditure in many health systems; in England it accounts for about 44% of total National Health Service (NHS) expenditure.[4] Studies[5,6,7,8,9,10,11,12,13] based on individual participant data have reported strong associations between increased body-mass index (BMI) and elevated hospital costs. Most of these studies were done on small-to-moderate numbers of participants, limiting their ability to estimate effects for different grades of obesity or the distribution of increased health-care costs across different health conditions. Policy analyses have been informed by studies using published epidemiological data to attribute part of the prevalence and cost burden of selected conditions to obesity.[14]
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