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Obesity linked to metabolic syndrome, high health care expense
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Obesity is correlated with a higher rate of cardiometabolic conditions and higher health care resource utilization and expense, according to a study published in Current Medical Research and Opinion.
In a retrospective, observational cohort study, Pravin S. Kamble, PhD, senior manager of Sunovion Pharmaceuticals, and colleagues identified 9,651 patients aged 18 to 89 years with at least one ICD-9 CM V85 BMI code between 2008 and 2012. The first recorded code was designated the index date. The researchers reviewed enrollment data files to collect patient demographic characteristics.
The ICD-9-CM code for dysmetabolic syndrome X was used to identify metabolic syndrome in the pre-index period. Metabolic syndrome was also determined through diagnosis codes or laboratory results suggesting the presence of at least three of the following: elevated waist circumference/central obesity, dyslipidemia, hypertension or impaired fasting blood glucose. For each individual in the analysis, the researchers also calculated Charlson Comorbidity Index score as a general measure of comorbidity. At baseline, medication use was assessed in terms of total number of pharmacy claims, number of medications and specific medication categories.
Medical claims were used to determine health care resource utilization. The use and number of health care encounters were established for inpatient admissions, ED visits and outpatient visits.
Representation of the U.S. commercially insured population was established using sampling weights developed using the entropy balance method and National Health and Nutrition Examination Survey data. The researchers characterized baseline traits across BMI classes and associations between BMI categories, with multivariable regression used to evaluate outcomes.
Researchers found that normal-weight individuals were younger than those in the overweight and obese BMI categories. There was a higher proportion of black patients in the higher BMI strata, whereas the percentage of white individuals decreased in proportion to increasing BMI levels.
Increasing BMI was associated with increasing Deyo-Charlson Comorbidity Index and proportion of metabolic syndrome, type 2 diabetes, hypertension, coronary artery disease, myocardial infarction, congestive heart failure, pulmonary embolism and stroke. There was also an increase in conditions such as asthma, chronic obstructive pulmonary disease, sleep apnea, depression and chronic back pain in proportion to increased BMI levels.
The researchers also found that with increasing levels of BMI, there was an increase in the percentage of at least one inpatient visit (normal BMI, 16.8%; overweight, 23.1%; obesity class I, 30.2%; obesity class II, 35.1%; and obesity class III, 55.9%). Moreover, there was an increase in the percentage of at least one ED visit with high BMI levels (normal, 11.3%; overweight, 16.3%; obesity class I, 17.7%; obesity class II, 21.6%; and obesity class III, 27%).
After controlling for age, sex, race, geographic region, health plan type, Deyo-Charlson Comorbidity Index and number of medications used during the study period, the researchers found an increase in outpatient visits based on increased BMI category. There was a 12% increase (incidence rate ratio [IRR] = 1.12; 95% CI, 1.07-1.16) in outpatient visits among those with obesity class I, a 27% increase (IRR = 1.27; 95% CI, 1.21-1.34) in patients with obesity class II, and a 22% increase (IRR = 1.22; 95% CI, 1.16-1.28) in patients in obesity class III vs. those with normal BMI. The following increases were seen in ED visits based on increasing BMI categories: overweight, 25% (IRR = 1.25; 95% CI, 1.05-1.49); obesity class II, 53% (IRR = 1.53; 95% CI, 1.21-1.93); and obesity class III, 201% (IRR = 2.01; 95% CI, 1.58-2.53).
Higher BMI categories were also associated with increased use of medications such as antihypertensives, antilipidemics, antidiabetics, narcotic and non-narcotic painkillers, and antidepressants.
“These results further emphasize the urgency of addressing the epidemic of obesity, and the subsequent clinical and economic impact on patients and the health care system,” the researchers wrote. “Further research is necessary to fully characterize the utility of administrative claims data to assign BMI, potential bias in coding obesity on medical claims and the potential for use of V85 codes to identify patients for obesity care management intervention.” – by Jennifer Byrne
Disclosures: The study was funded by Novo Nordisk. Kamble reports he is an employee of Comprehensive Health Insights, a subsidiary of Humana. Please see the study for all other authors’ relevant financial disclosures.
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