The association between adiposity and inpatient hospital costs in the UK Biobank cohort

Abstract

BackgroundHigh adiposity is associated with higher risks for a variety of adverse health outcomes, including higher rates of age-adjusted mortality and increased morbidity. This has important implications for the management of healthcare systems, since the endocrinal, cardiometabolic and other changes associated with increased adiposity may be associated with substantial healthcare costs. MethodsWe studied the association between various measures of adiposity and inpatient hospital costs through record linkage between UK Biobank and records of inpatient care in England and Wales. UK Biobank is a large prospective cohort study that aimed to recruit men and women aged between 40 and 69 from 2006 to 2010. We applied generalised linear models to cost per person year to estimate the marginal effect and averaged adjusted predicted cost of adiposity on inpatient costs. Results Validcost and body mass index (BMI) data from 457,689 participants were available for inferential analysis. Some 54.4% of individuals included in the analysis sample had positive inpatient healthcare costs over the period of follow-up. Median hospital costs per person year of follow-up were £89, compared to mean costs of £481. Mean BMI overall was 27.4 kg/m2 (standard deviation 4.8). The marginal effect of a unit increase in BMI was £13.61 (99% confidence interval: £12.60 to £14.63) per person year of follow up. The marginal effect of a standard deviation increase in BMI was £69.20 (99% confidence interval: £64.98 to £73.42). The marginal effect of becoming obese was £136.35 (99% confidence interval:£124.62 to £148.08). Average adjusted predicted inpatient hospital costs increased almost linearly when modelled using continuous measure of adiposity. Sensitivity analysis of different scenarios did not substantially change these conclusions, although there was some evidence of attenuation of the effects of adiposity when controlling for waist-hip ratios, and when individuals who self-reported any pre-existing conditions were excluded from analysis. ConclusionsHigher adiposity is associated with higher inpatient hospital costs. Further scrutiny using causal inferential methods is warranted to establish if further public health investments are

BMI and Cause‐Specific Hospital Admissions and Costs: The UK Biobank Cohort Study

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“…These associations between BMI and annual costs are broadly consistent with other large and high-quality studies from the UK and elsewhere (8,(11)(12)(13)22). Based on the same cohort, Dixon et al (13) reported that a 2-kg/m 2 higher BMI was associated with an approximately 5.9% higher cost across the entire BMI range. Similarly, using data on over 1 million women aged 55 to 79 years in England, Kent et al (12) reported that every additional 2 kg/m 2 above 20 kg/m 2 was associated with 7.7% higher costs, which compares with 8.4% higher costs in the present study.…”

“…The largest UK study reported that, among 1 million middle-aged and older women, excess weight was associated with a substantially higher number of hospital admissions and substantially higher costs, overall and for a wide range of conditions, but this study presented no data from men or younger adults (12). Hospital costs were also found to be higher in people with a higher BMI among 500,000 men and women aged 40 years or older in the UK Biobank, but the authors did not assess the associations by population strata or for different health conditions (13).…”

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