Aging is a strong risk factor for many chronic diseases. However, the impact of an aging population on the prevalence of chronic diseases and related healthcare costs are not known. We used a prevalence‐based approach that combines accurate clinical and drug prescription data from Health Search CSD‐LPD. This is a longitudinal observational data set containing computer‐based patient records collected by Italian general practitioners (GP) and up‐to‐date healthcare expenditures data from the SiSSI Project. The analysis is based on data collected by 900 GP on an unbalanced sample of more than 1 million patients aged 35+, observed in different time periods between 2005 and 2014. In 2014, 86% of the Italian adults older than 65 had at least one chronic condition, and 56.7% had two or more. Prevalence of multiple chronic diseases and healthcare utilization increased among older and younger adults between 2004 and 2014. Indeed, in the last 10 years, average number of prescriptions increased by approximately 26%, while laboratory and diagnostic tests by 27%. The average number of DDD prescribed increased with age in all the observed years (from 114 in 2005 to 119.9 in 2014 for the 35–50 age group and from 774.9 to 1,178.1 for the 81+ patients). The alarming rising trends in the prevalence of chronic disease and associated healthcare costs in Italy, as well as in many other developed countries, call for an urgent implementation of interventions that prevent or slow the accumulation of metabolic and molecular damage associated with multiple chronic disease.

In this article, we empirically study the role of education attainment on individual body mass index (BMI), eating patterns, and physical activity. We allow for endogeneity of schooling choices for females and males in a mean and quantile instrumental variables framework. We find that completion of lower secondary education has a significant positive impact on reduction of individual BMI, containment of calorie consumption, and promotion of physical activity. Interestingly, these effects are heterogeneous across genders and distributions. In particular, for BMI and calorie expenditure, the effect of education is significant for females and is more pronounced for women with high body mass and low physical activity. On the other hand, the effect of education on eating patterns is significant mainly for males, being more beneficial for men with elevated calorie consumption. We also show that education attainment is likely to foster productive and allocative efficiency of individuals in the context of BMI formation. Given that the literature suggests that education fosters development of cognition, self-control, and a variety of skills and abilities, in our context it is thus likely to promote lifetime preferences and means of individuals, which in turn enable them to achieve better health outcomes. Education also provides exposure to physical education and to school subjects enhancing individual deliberative skills, which are important factors shaping calorie expenditure and intake. Finally, we show that in the presence of strong socioeconomic inequalities in BMI, education is likely to have a pronounced impact on healthy BMI for the disadvantaged groups, represented in our framework by females.

Aging and excessive adiposity are both associated with an increased risk of developing multiple chronic diseases, which drive ever increasing health costs. The main aim of this study was to determine the net (non‐estimated) health costs of excessive adiposity and associated age‐related chronic diseases. We used a prevalence‐based approach that combines accurate data from the Health Search CSD‐LPD, an observational dataset with patient records collected by Italian general practitioners and up‐to‐date health care expenditures data from the SiSSI Project. In this very large study, 557,145 men and women older than 18 years were observed at different points in time between 2004 and 2010. The proportion of younger and older adults reporting no chronic disease decreased with increasing BMI. After adjustment for age, sex, geographic residence, and GPs heterogeneity, a strong J‐shaped association was found between BMI and total health care costs, more pronounced in middle‐aged and older adults. Relative to normal weight, in the 45‐64 age group, the per‐capita total cost was 10% higher in overweight individuals, and 27 to 68% greater in patients with obesity and very severe obesity, respectively. The association between BMI and diabetes, hypertension and cardiovascular disease largely explained these elevated costs.

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