Relation of Body Mass Index in Young Adulthood and Middle Age to Medicare Expenditures in Older Age

Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill 60611, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 01/2005; 292(22):2743-9. DOI: 10.1001/jama.292.22.2743
Source: PubMed


Increasing prevalence of overweight/obesity and rapid aging of the US population have raised concerns of increasing health care costs, with important implications for Medicare. However, little is known about the impact of body mass index (BMI) earlier in life on Medicare expenditures (cardiovascular disease [CVD]-related, diabetes-related, and total) in older age.
To examine relationships of BMI in young adulthood and middle age to subsequent health care expenditures at ages 65 years and older.
Medicare data (1984-2002) were linked with baseline data from the Chicago Heart Association Detection Project in Industry (CHA) (1967-1973) for 9978 men (mean age, 46.0 years) and 7623 women (mean age, 48.4 years) (baseline overall age range, 33 to 64 years) who were free of coronary heart disease, diabetes, and major electrocardiographic abnormalities, were not underweight (BMI <18.5), and were Medicare-eligible (> or =65 years) for at least 2 years during 1984-2002. Participants were classified by their baseline BMI as nonoverweight (BMI, 18.5-24.9), overweight (25.0-29.9), obese (30.0-34.9), and severely obese (> or =35.0).
Cardiovascular disease-related, diabetes-related, and total average annual Medicare charges, and cumulative Medicare charges from age 65 years to death or to age 83 years.
In multivariate analyses, average annual and cumulative Medicare charges (CVD-related, diabetes-related, and total) were significantly higher by higher baseline BMI for both men and women. Thus, with adjustment for baseline age, race, education, and smoking, total average annual charges for nonoverweight, overweight, obese, and severely obese women were, respectively, 6224 dollars, 7653 dollars, 9612 dollars, and 12,342 dollars (P<.001 for trend); corresponding total cumulative charges were 76, 866 dollars, 100,959 dollars, 125,470 dollars, and 174,752 dollars (P<.001 for trend). For nonoverweight, overweight, obese, and severely obese men, total average annual charges were, respectively, 7205 dollars, 8390 dollars, 10,128 dollars, and 13,674 dollars (P<.001 for trend). Corresponding total cumulative charges were 100,431 dollars, 109,098 dollars, 119,318 dollars, and 176,947 dollars (P<.001 for trend).
Overweight/obesity in young adulthood and middle age has long-term adverse consequences for health care costs in older age.

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Available from: Willard G Manning, Mar 10, 2014
    • "Although obesity rates have leveled off in recent years, obesity rates among older women have increased significantly from 2003 to 2012 (Flegal, Carroll, Kit, &amp; Ogden, 2012;Ogden, Carroll, Kit, &amp; Flegal, 2014). Obesity is problematic for any age group, but it can ex-acerbate many age-related chronic conditions (Villareal, Apovian, Kushner, &amp; Klein, 2005), leading to increased health services utilization—average annual Medicare expenditures are twice as much for severely obese beneficiaries compared to normal beneficiaries (Daviglus et al., 2004)—and increased need for nursing home (NH) care (Elkins et al., 2006;Valiyeva, Russell, Miller, &amp; Safford, 2006). This increased need may be due to obesity's negative effect on general strength, lower body mobility, and ability to perform activities of daily living (ADLs) among older adults (Jenkins, 2004). "
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    • "Obesity, on one hand, has been more recently considered an indicator of wellbeing (Katsaiti, 2012; Katsaiti and El Anshasy, 2013). On the other hand, significant literature on obesity links it to many chronic health conditions, which in turn deplete human capital and productivity (Thompson and Wolf, 2001; Raebel et al., 2002; Daviglus et al., 2004). Our study covers a large sample of countries and makes the distinction between different types of natural resources: agricultural, hydrocarbons, and minerals. "
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    ABSTRACT: Introduction: Obesity is one of the leading causes of preventable morbidity and mortality world-wide. The behavioural nature of the condition has been highlighted by the fact that it is largely the result of an energy imbalance between calories consumed and calories expended. In that respect, obesity related morbidity and mortality can be reduced through preventive behaviours. As behavioural scientists, economists have done little to date to explain and understand why the demand for obesity preventing activities is low. The aim of this paper is to develop an economic theory-based dynamic model to gain better understanding of people’s obesity preventive behaviours. Methods: A literature search using a PICO approach was developed to identify the relevant variables considered to influence the demand for obesity preventive goods. To inform the model, a framework was developed to group variables and help determine appropriate linkages between them. Results: Anchors, anxiety and anxiety driven variables are fundamental influences of people’s risk reduction actions. The anchors, which are environmental as well as personal in character, serve as references and stimulate anxieties. However, anxiety levels are driven by many other variables including stigma and perceived health outcomes. In response to one’s anxiety an individual will take actions which can be explained, at least in part, by conventional economic theories particularly in terms of costs and utilities. Conclusions: Conventional economic theories of consumer behaviour cannot fully explain the demand for obesity preventive goods. The model demonstrates that many factors have to be considered including health economic, psychological and behavioural economic theories. The model should be tested through a well designed questionnaire before using it in a general adult population.
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