Greater Resource Use Research Articles

Increased complementarity in water‐limited environments in Scots pine and European beech mixtures under climate change

AbstractManagement of mixedwoods is advocated as an effective adaptation strategy to increase ecosystem resiliency in the context of climate change. Although mixedwoods have been shown to have greater resource use efficiency relative to pure stands, considerable uncertainty remains with respect to the underlying ecological processes. We explored species interactions in Scots pine/European beech mixedwoods with the process‐based model FORECAST Climate. The model was calibrated for two contrasting forests in the southwestern Pyrenees (northern Spain): a wet Mediterranean site at 625 m.a.s.l. and a subalpine site at 1335 m.a.s.l. Predicted mixedwood yield was higher than that for beech stands but lower than pine stands. When simulating climate change, mixedwood yield was reduced at the Mediterranean site (−33%) but increased at the subalpine site (+11%). Interaction effects were enhanced as stands developed. Complementarity dominated the Mediterranean stand but neutral or net competition dominated the subalpine stand, which had higher stand density and water availability. Reduced water demand and consumption, increased canopy interception, and improved water‐use efficiency in mixtures compared to beech stands, suggest a release of beech intraspecific competition. Beech also facilitated pine growth through better litter quality, nonsymbiotic nitrogen fixation, and above‐ and belowground stratification, leading to higher foliar nitrogen content and deeper canopies in pines. In conclusion, mixtures may improve water availability and use efficiency for beech and light interception for pine, the main limiting factors for each species, respectively. Encouraging pine–beech mixtures could be an effective adaptation to climate change in drought‐prone sites in the Mediterranean region.

Soil Properties, Crop Yield, and Economics Under Integrated Crop Management Practices in Karnataka, Southern India

Summary Considering the importance of sustainable production practices with greater resource use efficiency, a study was conducted during 2009–12 to understand the soil properties, crop yield, and economics as affected by the integrated crop management (ICM) practices under the Bhoochetana (soil rejuvenation) program in Karnataka, India. Results from 3776 crop-cutting studies on different crops (cereals, pulses, and oilseeds) revealed that there is a vast spatial variability in case of various soil nutrients across different taluks of Karnataka. Balanced fertilizer application, both in rainfed and irrigated areas, directly influenced crop yields. Yields of cereals, legumes, and oilseeds were 3590, 1400, and 2230 kg ha −1 with improved management practices as compared to 2650, 1030, and 1650 kg ha −1 with conventional farming practices, respectively. Average net income estimated from conventional farming was Rs. 26,290 ha −1 , while it was Rs. 35,540 ha −1 from improved management practices, which indicated that ICM practices resulted in an additional 35% income. The oilseeds performed better in terms of achieving higher net income and benefit–cost ratio while the cereals and legumes also have shown significant improvement in yield compared to the yields from conventional farming practices. The detailed findings on soil properties, yields of crops, and economics suggested that there is a vast potential for crop productivity improvement through ICM practices across different soil types and rainfall zones of Karnataka, India.

Application of dynamic thermal engineering principles to improve the efficiency of resource use in UK pork production chains

This paper investigates the potential for incorporation of human commercial building design modelling into the pig production industry. During the last decades pig building design has relied heavily on building manufacturers compared to human commercial buildings that regulate standards to improve the sustainability of the building. Thus, the aim of this paper was to gain a greater understanding of the design requirements for sustainable forms of pig housing, which could potentially improve the welfare of the pig and promote greater resource use efficiency. Part of an existing mechanically ventilated UK pig production building, which represents three adjacent fully-slatted units each capable of holding approximately 292 pigs and measuring approximately 18m x 14m, was used as a basis to create a dynamic thermal model of the building. The model takes into account the possibility of future rises in environmental temperature and the effect of this climate change on building performance and pig growth, feed efficiency and welfare. The results of the model showed that as the finishing pigs increased in size they have the potential to be subject to increasingly poor indoor air quality, during the winter months. The model also shows that improving the thermal properties of the building not only helps with reducing the amount of time that the pigs could potentially spend at extreme low temperatures, by approximately 1115h (46days), but can also help with reducing the number of hours the pigs spend above 26°C during the summer months, by approximately 8h.

Clinical Characteristics, Health Care Utilization and Costs Among Men with Primary or Secondary Hypogonadism in a US Commercially Insured Population

IntroductionHypogonadism is broadly associated with increases in chronic comorbid conditions and health care costs. Little is known about the specific impact of primary and secondary hypogonadism on health care costs. AimTo characterize the health care cost and utilization burden of primary and secondary hypogonadism in a population of US men with commercial insurance. MethodsNewly diagnosed patients with International Classification of Diseases, Ninth Revision, Clinical Modification codes associated with specific medical conditions known to have a high prevalence of testosterone deficiency (ie, relating to primary or secondary hypogonadism) or who had fills for testosterone replacement therapy from January 1, 2007 through April 30, 2013 were identified in administrative claims data from the HealthCore Integrated Research Database. A cohort of patients without hypogonadism was matched on demographics and comorbidities. The matched hypogonadism and non-hypogonadism cohorts (n = 5,777 in each cohort) were compared during a 12-month follow-up period. Main Outcome MeasuresDirect health care expenditures and utilization were assessed for all causes and for hypogonadism-related claims. Costs included out-of-pocket patient expenditures and those paid by the insurer. ResultsHypogonadism and matched non-hypogonadism cohorts were similar in demographics (mean age = 50 years) and diagnosed comorbid conditions in the 12 months preceding the index date. In the year after the index date, mean all-cause expenditures for patients with hypogonadism increased by 62% (from $5,425 to $8,813) compared with 25% for the matched controls (from $4,786 to $5,992; P < .01 for follow-up difference between groups). Approximately 16% of total mean costs ($1,377), primarily outpatient and pharmacy costs, were identifiable as related to hypogonadism. ConclusionThese data from a population of US men with commercial insurance coverage showed a greater resource use burden for patients with primary and secondary hypogonadism compared with similar patients without hypogonadism. Additional management might be required to address unmet need and decrease the cost burden for patients with hypogonadism.

The Burden of Poor Mental Well-being Among Patients With Type 2 Diabetes Mellitus: Examining Health Care Resource Use and Work Productivity Loss.

Objective:The aim of this study was to evaluate the association of mental well-being with outcomes among patients with type 2 diabetes mellitus (T2DM).Methods:Seven thousand eight hundred fifty-two adults with T2DM were identified from a national, Internet-based study. Mental well-being [SF-36v2 mental component summary (MCS)] was categorized as good (MCS ≥ 50), poor (40 ≤ MCS < 50), and very poor (MCS < 40). Outcomes included past 6 months of health care resource use and lost productivity (Work Productivity and Activity Impairment questionnaire).Results:Respondents with very poor/poor versus good mental well-being were more likely to visit the emergency room (27%/18% vs 11%, P < 0.001) or be hospitalized (19%/14% vs 9%, P < 0.001). Among labor force participants, those with very poor/poor versus good mental well-being experienced greater overall work impairment (43.7/26.0 vs 10.7, P < 0.001).Conclusions:Greater resource use and work productivity impairment associated with poorer mental well-being among patients with T2DM has cost implications.

The economic burden of tuberous sclerosis complex in the UK: A retrospective cohort study in the Clinical Practice Research Datalink

Background: Tuberous sclerosis complex (TSC) is a multi-system genetic disorder characterized by the development of diverse clinical manifestations. The complexity of this disease is likely to result in substantial challenges and costs in disease management throughout the patient’s lifetime. This retrospective database study aims to quantify healthcare resources utilized by TSC patients.Methods: TSC patients in the Clinical Practice Research Datalink linked to the Hospital Episodes Statistics database were identified between January 1987 and June 2013. Analyses were conducted over the most recent 3-year period of data and stratified by pediatric (< 18) and adult patients. Prescriptions, procedures, diagnostic tests, and healthcare encounters were reported in comparison with a matched comparator cohort. Costs and key economic drivers by primary organ system manifestations were also examined.Results: A total of 286 patients with TSC were identified and consistently reported 2-fold greater resource use than the matched presumably healthy controls. Despite this comparatively greater resource use, half of TSC patients did not record any procedures, and 20% of patients did not record any diagnostic tests; however, inpatient hospitalizations were greater for the TSC cohort (3.1 vs 1.3), but length of stay was comparable. TSC patients had costs totaling £12,681 per patient over the 3-year period, a figure 2.7-fold greater than the total costs in the comparator cohort (£4,777). Costs for patients with specific primary manifestations were even greater, with brain manifestations incurring £22,139 per affected patient. Kidney and nervous system manifestations were the main cost drivers.Conclusions: The economic burden of TSC and its impact on NHS healthcare resources is mostly attributable to the broad spectrum of manifestations that develop within multiple organ systems. TSC patients may benefit from co-ordinated care based on their requirement for high numbers of healthcare visits across specialties.

The Humanistic and Economic Burden of Narcolepsy.

To evaluate the burden of narcolepsy--with respect to psychiatric comorbidities, Health-Related Quality of Life (HRQoL), direct costs for healthcare resource utilization, and indirect costs for reported work loss-through comparison of patients to matched controls. This analysis was conducted on data from the 2011, 2012, and 2013 US National Health and Wellness Survey (NHWS; 2011 NHWS n = 75,000, 2012 NHWS n = 71,157, and 2013 NHWS n = 75,000). Patients who reported a narcolepsy diagnosis (n = 437) were matched 1:2 with controls (n = 874) on age, sex, race/ethnicity, marital status, education, household income, body mass index, smoking status, alcohol use, exercise, and physical comorbidity. Chi-square tests and one-way analyses of variance were used to assess whether the narcolepsy and control groups differed on psychiatric comorbidities, HRQoL, labor force participation, work productivity, and healthcare resource utilization. Patients with narcolepsy, in comparison to matched controls, reported substantially (two to four times) greater psychiatric comorbidity, HRQoL impairment, prevalence of long-term disability, absenteeism, and presenteeism, and greater resource use in the past 6 mo as indicated by higher mean number of hospitalizations, emergency department visits, traditional healthcare professional visits, neurologist visits, and psychiatrist visits (each p < 0.05). These population-based data suggest that a narcolepsy diagnosis is associated with substantial adverse impact on mental health, HRQoL, and key economic burdens that include work impairment, resource use, and both direct and indirect costs. Although this study is cross-sectional, the results highlight the magnitude of the potential opportunity to improve mental health, lower costs, and augment work-related productivity through effective assessment and treatment of narcolepsy.

Clinical features of kinesthetic hallucinations in cocaine-dependent patients

IntroductionLegal and illegal drugs can cause psychotic symptoms, in cocaine-dependent patients the prevalence of these symptoms may reach 86% (Vorspan, 2012). It is estimated that 13–32% of cocaine-dependent patients have kinaesthetic hallucinations (Siegel, 1978; Mahoney, 2008; Roncero, 2012).ObjectivesTo compare the prevalence of substance-induced psychotic symptoms and compare the use of welfare/social resources and social adjustment among cocaine-dependent patients (CD) and other substances dependences (OtherD).MethodsTwo hundred and six patients seeking treatment at the Addictions and Dual Diagnosis Unit of the Vall d’Hebron. Patients were assessed by ad hoc questionnaire designed to collect demographic data and psychotic symptoms associated with consumption, a record of the care/social resources used by the patient and the scale of social adaptation (SASS). A descriptive and bivariate analysis of the data was performed.ResultsCD were 47.1% vs. 52.9% OtherD (66.1% alcohol, 17.4% cannabis, 8.3% opioid, 8.3% benzodiazepines/other drugs). Of cocaine dependent-patients, 65.6% present psychotic symptoms vs. 32.1% for the OtherD. Different exhibiting psychotic symptoms are: self-referential (69.7% vs. 30.7%), delusions of persecution (43.4% vs. 12.2%), hallucinations (49.4% vs. 14.3%), auditory hallucinations (43.5% vs. 11.4%), visual hallucinations (30.4% vs. 5.7%) and kinaesthetic hallucinations (7.2% vs. 2.9%).Cocaine-dependent patients significantly use more health care resources in reference addiction unit (76.3% vs. 62.4%, P:.035) and infectious diseases (22.7% vs. 5.5%, P:.000) and justice-related (50.5% vs. 26 resources 0.6%; P:1.001) and less resources and mental health (25.8% vs. 43.1%; P:.013).Regarding social adaptation, no differences were found in the SASS. Kinaesthetic hallucinations do not appear to be related to a greater use of resources and in social adaptation.References not available.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Understanding the Jevons paradox

There is considerable debate about the connections between efficiency and levels of resource consumption, particularly about the Jevons paradox and the rebound effect. To help clarify a variety of misunderstandings, we distinguish between the empirical claim that efficiency is often associated with rising resource consumption and the causal claim that efficiency leads to greater resource use. We show that at a variety of levels, a positive correlation between efficiency and resource consumption is common, suggesting that there is something to be explained. We then present various reasons that may explain these associations, some of which do not suggest a direct causal link between efficiency and consumption, but rather a connection through other mediating factors, and some of which do suggest a causal connection. We note that political economic theories propose that the effect of efficiency on consumption levels is not necessarily immediate and direct, but rather due to how it affects developmental pathways. We present an empirical analysis, using panel data on nations, which shows that more efficient nations tend to have higher rates of growth in electricity and overall energy consumption and carbon dioxide emissions, consistent with what political economic theories suggest.

Survival, Hospitalization, and Acute-Care Costs of Very and Moderate Preterm Infants in the First 6 Years of Life: A Population-Based Study

To investigate survival, hospitalization, and acute-care costs of very (28-31 weeks' gestation) and moderate preterm (32-33 weeks' gestation) infants in the first 6 years of life and compare outcomes with the more widely studied extremely preterm infants (24-27 weeks' gestation) and to full term (low risk) infants (39-40 weeks' gestation). Birth data from all women residing in New South Wales, Australia, with gestational ages between 24-33 and 39-40 weeks in 2001-2011 were linked probabilistically to hospitalization and mortality data. Study outcomes were evaluated with the use of descriptive and multivariable analyses at birth (N = 559,532), discharge (N = 540,240), and at 1 (N = 487,447) and 6 years of age (N = 230,498). Mortality was greatest among extremely preterm infants (eg, 31.2% within 6 years) and decreased with increasing gestational age. Likewise, hospitalization within the first year of life increased with decreasing gestational age (aOR 5.5 [95% CI 4.7-6.4], 3.7 [3.4-4.0], and 2.6 [2.5-2.8] for birth at 24-27, 28-31, and 32-33 weeks' gestation, relative to 39-40 weeks' gestation). Hospitalization remained significantly increased with preterm birth at each year of age up to 6 years (aORs 1.3-1.6 at 6 years). Cumulative costs were significantly greater with preterm birth within the first year of life, and also between 1 and 6 years of age. The risks of adverse health outcomes were significantly greater in very and moderately preterm infants relative to full term infants but lower than extremely preterm infants. Crucially, preterm birth was associated with prolonged increased odds of hospitalization (up to age 6 years), contributing to greater resource use.

Physician spending and subsequent risk of malpractice claims: observational study

Study question Is a higher use of resources by physicians associated with a reduced risk of malpractice claims?Methods Using data on nearly all admissions to acute care hospitals in Florida...

Financial burdens and barriers to care among nonelderly adults: The role of functional limitations and chronic conditions

BackgroundPeople with functional limitations and chronic conditions account for the greatest resource use within the health care system. ObjectiveTo examine financial burdens and barriers to care among nonelderly adults, focusing on the role of functional limitations and chronic conditions. MethodsHigh financial burden is defined as medical spending exceeding 20 percent of family income. Financial barriers are defined as delaying care/being unable to get care for financial reasons, and reporting that delaying care/going without was a big problem. Data are from the Medical Expenditure Panel Survey (2008–2012). ResultsFunctional limitations are associated with increased prevalence of financial burdens. Among single adults, the frequency of high burdens is 20.3% for those with functional limitations, versus 7.8% for those without. Among those with functional limitations, those with 3 or more chronic conditions are twice as likely to have high burdens compared to those without chronic conditions (22.2% versus 11.1%, respectively). Similar patterns occur among persons in multi-person families whose members have functional limitations and chronic conditions. Having functional limitations and chronic conditions is also strongly associated with financial barriers to care: 40.2% among the uninsured, 21.9% among those with public coverage, and 13.6% among those with private group insurance were unable to get care. ConclusionsFunctional limitations and chronic conditions are associated with increased prevalence of burdens and financial barriers in all insurance categories, with the exception that an association between functional limitations and the prevalence of burdens was not observed for public coverage.

Optimizing Rubisco and its regulation for greater resource use efficiency.

Rubisco catalyses the carboxylation of ribulose-1,5-bisphosphate (RuBP), enabling net CO2 assimilation in photosynthesis. The properties and regulation of Rubisco are not optimal for biomass production in current and projected future environments. Rubisco is relatively inefficient, and large amounts of the enzyme are needed to support photosynthesis, requiring large investments in nitrogen. The competing oxygenation of RuBP by Rubisco decreases photosynthetic efficiency. Additionally, Rubisco is inhibited by some sugar phosphates and depends upon interaction with Rubisco activase (Rca) to be reactivated. Rca activity is modulated by the chloroplast redox status and ADP/ATP ratios, thereby mediating Rubisco activation and photosynthetic induction in response to irradiance. The extreme thermal sensitivity of Rca compromises net CO2 assimilation at moderately high temperatures. Given its central role in carbon assimilation, the improvement of Rubisco function and regulation is tightly linked with irradiance, nitrogen and water use efficiencies. Although past attempts have had limited success, novel technologies and an expanding knowledge base make the challenge of improving Rubisco activity in crops an achievable goal. Strategies to optimize Rubisco and its regulation are addressed in relation to their potential to improve crop resource use efficiency and climate resilience of photosynthesis.

Epidemiology and outcomes of acute kidney injury in critically ill surgical patients

PurposeAcute kidney injury (AKI) is common in critically ill patients but is poorly defined in surgical patients. We studied AKI in a representative cohort of critically ill surgical patients. MethodsThis was a retrospective 1-year cohort study of general surgical intensive care unit patients. Patients were identified from a prospective database, and clinical data were reviewed. Acute kidney injury events were defined by risk, injury, failure, loss, and end-stage renal classification criteria. Outcomes were inpatient and 1-year mortality, inpatient lengths of stay, and discharge renal function. Risk factors for AKI and outcomes were compared by univariate and multivariate analyses. ResultsOf 624 patients, 296 (47%) developed AKI. Forty-two percent of events were present upon admission, whereas 36% occurred postoperatively. Risk, injury, failure, loss, and end-stage renal classification distributions by grade were as follows: risk, 152 (51%); injury, 69 (23%); and failure, 75 (25%). Comorbid diabetes, emergency admission, major surgery, sepsis, and illness severity were independently associated with renal dysfunction. Patients with AKI had significantly worse outcomes, including increased inpatient and 1-year mortality. Acute kidney injury starting before admission was associated with worse renal dysfunction and greater renal morbidity than de novo inpatient events. ConclusionsAcute kidney injury is common in critically ill surgical patients and is associated with increased mortality, persisting renal impairment and greater resource use.

Recurrent kidney injury in critically ill surgical patients is common and associated with worse outcomes.

Supplemental digital content is available in the text. Acute kidney injury (AKI) is common in critically ill surgery patients. Patients who recover are at risk for recurrence, but recurrent kidney injury (RKI) is not well studied. This was a retrospective 12-month cohort study of adults consecutively admitted to a noncardiac, non-trauma surgical intensive care unit. Patients were identified from a prospective critical care database, and kidney injury events were diagnosed and graded by RIFLE criteria. Patients who recovered from AKI were analyzed, and the primary end point was RKI (defined as kidney injury occurring after recovery from an index AKI event). Outcomes were inpatient and 1-year mortality, inpatient lengths of stay, and discharge creatinine. Of 624 patients, 296 (47%) had AKI and 216 (73%) recovered. Of these, 68 (31%) developed RKI. AKI in progress on hospital admission was associated with recurrence, but otherwise RKI and non-RKI patients had similar demographics, comorbidities, and inpatient clinical factors. Recurrence was associated with significantly higher inpatient and 12-month mortality, greater resource use, and worse discharge renal function. RKI is common among critically ill surgical patients who recover from an index episode. Recurrence is a clinically significant event and is associated with worse renal and patient outcomes. Future studies should further define this process. Prognostic and epidemiologic study, level III.

AB1117 Burden of Disease in Systemic Lupus Erythematosus Patients Treated with Corticosteroids

ObjectivesCurrent treatments for systemic lupus erythematosus (SLE) include corticosteroids (CS), immunosuppressants (IM), antimalarials (AM) and biologics. SLE treatments, in particular CS, are associated with adverse effects which impact tolerability and...

Triggering Factors of Primary Care Costs in the Years Following Type 2 Diabetes Diagnosis in Mexico

Diabetes represents a high epidemiological and economic burden worldwide. The cost of diabetes care increases slowly during early years, but it accelerates once chronic complications set in. There is evidence that adequate control may delay the onset of complications. Management of diabetes falls almost exclusively into primary care services until chronic complications appear. Therefore, primary care is strategic for reducing the expedited growth of costs. The objective of this study was to identify predictors of primary care costs in patients without complications in the years following diabetes diagnosis. Direct medical costs for primary care were determined from the perspective of public health services provider. Information was obtained from medical records of 764 patients. Microcosting and average cost techniques were combined. A generalized linear regression model was developed including characteristics of patients and facilities. Primary health care costs for different patient profiles were estimated. The mean annual primary care cost was USD$465.1. Gender was the most important predictor followed by weight status, insulin use, respiratoty infections, glycemic control and dyslipidemia. A gap in costs was observed between genders; women make greater use of resources (42.1% on average). Such differences are reduced with obesity (18.1%), overweight (22.8%), respiratory infection (20.8%) and age >80 years (26.8%). Improving glycemic control shows increasing costs but at decreasing rates. Modifiable factors (glycemic control, weight status and comorbidities) drive primary care costs the first 10 years. Those factors had a larger effect in costs for males than in for females.

Economic burden of methicillin-resistant Staphylococcus aureus bacteremia in critical care patients in hospitals in Bogotá

Resistant infections, especially those involving the bloodstream, are associated with a greater use of resources. Their estimates are variable and depend on the methodology used. Staphylococcus aureus is the main pathogen isolated in blood in our hospitals. There is no consolidated data about economic implications of methicillin-resistant S. aureus infection. To describe the cost of care of methicillin-resistant S. aureus bacteremia in a reference population from nine hospitals in Bogotá. Materials y methods: A multicenter cohort study included 204 patients in a 1:1 ratio according to resistance. Direct medical costs were calculated from hospitalization bills, while the bacteremia period was calculated by applying microcosting based on standard fares. We found no significant differences between groups in demographic and clinical characteristics, except for resistance risk factors. Fifty-three percent of patients died during hospitalization. Hospital stay and total invoiced value during hospitalization were significantly higher in the group with methicillin-resistant S. aureus bacteremia. For this group, higher costs in ICU stay, antibiotics use, intravenous fluids, laboratory tests and respiratory support were recorded. A crude increase of 31% and an adjusted increase of 70% in care costs associated with methicillin resistance were registered. Our study supports decision makers in finding and funding infection prevention programs, especially those infections caused by resistant organisms.

Impacto económico de la resistencia a meticilina en pacientes con bacteriemia por Staphylococcus aureus en hospitales de Bogotá

Introduction: Resistant infections, especially those involving the bloodstream, are associated with a greater use of resources. Their estimates are variable and depend on the methodology used. Staphylococcus aureus is the main pathogen isolated in blood in our hospitals. There is no consolidated data about economic implications of methicillin-resistant S. aureus infection.Objective: To describe the cost of care of methicillin-resistant S. aureus bacteremia in a reference population from nine hospitals in Bogotá.Materials y methods: A multicenter cohort study included 204 patients in a 1:1 ratio according to resistance. Direct medical costs were calculated from hospitalization bills, while the bacteremia period was calculated by applying microcosting based on standard fares.Results: We found no significant differences between groups in demographic and clinical characteristics, except for resistance risk factors. Fifty-three percent of patients died during hospitalization. Hospital stay and total invoiced value during hospitalization were significantly higher in the group with methicillin-resistant S. aureus bacteremia. For this group, higher costs in ICU stay, antibiotics use, intravenous fluids, laboratory tests and respiratory support were recorded. A crude increase of 31% and an adjusted increase of 70% in care costs associated with methicillin resistance were registered.Conclusion: Our study supports decision makers in finding and funding infection prevention programs, especially those infections caused by resistant organisms.

Uso de recursos y costos asociados a las fracturas en mujeres españolas

The objective of the study was to determine the use of resources and costs due to bone fractures in Spanish women above 50 years of age in the population scope. An observational and retrospective study was conducted in six primary care centers and two urban hospitals in Spain. Socio-demographic and co-morbidity data, use of resources (primary care consultations, complementary tests, medications, specialized care, hospitalizations, visits, urgencies), costs and productivity losses were registered. Records of 19 022 women were included, 7% showed some type of fracture between 2003 and 2007. Fractures were mostly associated with osteoporosis (OR: 3.2), fibromyalgia (OR: 2.4) and thyroid changes (OR: 2.2). In the corrected model, the total cost for patients who had a fracture was USD 3727 compared to USD 2705.5 (p&lt;0.001) for those who did not have it. Patients with a fracture generate a greater use of resources, sanitation costs and work productivity losses.