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The Association Between Adiposity and Inpatient Hospital Costs in the UK Biobank Cohort

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The Association Between Adiposity and Inpatient Hospital Costs in the UK Biobank Cohort. / Dixon, Padraig; Davey Smith, George; Hollingworth, William.

In: Applied Health Economics and Health Policy, Vol. 17, No. 3, 01.06.2019, p. 359-370.

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@article{9e4b33d0941c403fac611e7a597d8444,
title = "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. ResultsValid cost 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 required to manage the large healthcare costs observationally associated with overweight and obesity.",
author = "Padraig Dixon and {Davey Smith}, George and William Hollingworth",
year = "2019",
month = "6",
day = "1",
doi = "10.1007/s40258-018-0450-2",
language = "English",
volume = "17",
pages = "359--370",
journal = "Applied Health Economics and Health Policy",
issn = "1175-5652",
publisher = "Springer Verlag",
number = "3",

}

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TY - JOUR

T1 - The Association Between Adiposity and Inpatient Hospital Costs in the UK Biobank Cohort

AU - Dixon, Padraig

AU - Davey Smith, George

AU - Hollingworth, William

PY - 2019/6/1

Y1 - 2019/6/1

N2 - 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. ResultsValid cost 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 required to manage the large healthcare costs observationally associated with overweight and obesity.

AB - 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. ResultsValid cost 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 required to manage the large healthcare costs observationally associated with overweight and obesity.

UR - http://www.scopus.com/inward/record.url?scp=85059332646&partnerID=8YFLogxK

U2 - 10.1007/s40258-018-0450-2

DO - 10.1007/s40258-018-0450-2

M3 - Article

VL - 17

SP - 359

EP - 370

JO - Applied Health Economics and Health Policy

T2 - Applied Health Economics and Health Policy

JF - Applied Health Economics and Health Policy

SN - 1175-5652

IS - 3

ER -