Abstract
BackgroundThe extent to which uncomplicated obesity among an otherwise healthy middle-aged population is associated with higher longitudinal health-care expenditures remains unclear.MethodsTo examine the incremental long-term health service expenditures and outcomes associated with uncomplicated obesity, 9398 participants of the 1994–1996 National Population Health Survey were linked to administrative data and followed longitudinally forward for 11.5 years to track health service utilization costs and death. Patients with pre-existing heart disease, those who were 65 years of age and older, and those with self-reported body mass indexes of <18.5 kg/m2 at inception were excluded. Propensity-matching was used to compare obesity (+/− other baseline risk-factors and lifestyle behaviours) with normal-weight healthy controls. Cost-analyses were conducted from the perspective of Ontario’s publicly-funded health care system.ResultsObesity as an isolated risk-factor was not associated with significantly higher health-care costs as compared with normal weight matched controls (Canadian $8,294.67 vs. Canadian $7,323.59, P = 0.27). However, obesity in combination with other lifestyle factors was associated with significantly higher cumulative expenditures as compared with normal-weight healthy matched controls (CAD$14,186.81 for those with obesity + 3 additional risk-factors vs. CAD$7,029.87 for those with normal BMI and no other risk-factors, P < 0.001). The likelihood that obese individuals developed future diabetes and hypertension also rose markedly when other lifestyle factors, such as smoking, physical inactivity and/or psychosocial distress were present at baseline.ConclusionsThe incremental health-care costs associated with obesity was modest in isolation, but increased significantly when combined with other lifestyle risk-factors. Such findings have relevance to the selection, prioritization, and cost-effective targeting of therapeutic lifestyle interventions.
Highlights
The extent to which uncomplicated obesity among an otherwise healthy middle-aged population is associated with higher longitudinal health-care expenditures remains unclear
The objective of our study was to examine the cumulative longitudinal health system expenditures and outcomes associated with obesity among a cohort of middle-aged adults in Ontario Canada, all of whom were free from cardiovascular disease at inception, and to compare these data with propensity-matched normal weight healthy controls
Study population To ensure we examined a relatively homogenous disease-free middle-aged population, we excluded all individuals with known heart disease at baseline, those ≥ 65 years of age, and underweight individuals (Figure 1), given that the development of chronic disease and health care expenditures in these subgroups are likely mediated by factors other than obesity alone [8,9,10,11]
Summary
The extent to which uncomplicated obesity among an otherwise healthy middle-aged population is associated with higher longitudinal health-care expenditures remains unclear. Few studies have disentangled the independent effects of obesity from other riskfactors and disease-related complications that arise over time [1]. Such studies require longitudinal follow-up of a population who are free of cardiovascular disease at inception, so that forthcoming health system expenditures reflect the emergence of new incident diseases that occur during follow-up rather than pre-existing diseases already present at baseline. The impact of obesity on health-care expenditures may vary according to the presence or absence of other concomitant lifestyle behaviours. Delineating high-risk, high-cost lifestyle risk-factor combinations may help direct, focus, and target policy lifestyle interventions for obesity
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