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Obesity associated with lower-quality end-of-life care

High BMI is a risk factor for reduced hospice use, increased in-home death and greater Medicare expenditures in the 6 months before death, according to research published in Annals of Internal Medicine.

“Seventy percent of U.S. adults aged 60 years or older are overweight or obese,” John A. Harris, MD, MSc, from the University of Michigan, Ann Arbor, and colleagues wrote.

“For obese persons, technical and logistical issues arise during hospitalizations, surgery, and end-of-life care that require special attention,” they added. “To date, however, no studies have examined the association between obesity and hospice use, a cornerstone of end-of-life care.”

To address this issue, Harris and colleagues conducted a retrospective cohort investigation of 5,677 Medicare fee-for-service beneficiaries who participated in the Health and Retirement Study and died between 1998 and 2012. They examined data on participants’ BMI, hospice enrollment, days enrolled in hospice, in-home death and total Medicare expenditures in the last 6 months of life. Data were adjusted for sociodemographic, medical, functional status and geographic factors.

Overall, data indicated that increasing BMI was independently linked to suboptimal end-of-life care. Compared with decedents with a lower BMI (20 kg/m²), those with a higher BMI (≥30 kg/m²) had a 40% lower hospice enrollment rate, a shorter hospice duration, a higher in-home death rate and a 13% higher Medicare expenditure rate.

“The consequences of obesity for health care use and expenditures are substantial, and obese persons are vulnerable to suboptimal end-of-life care,” Harris and colleagues concluded. “As stakeholders look for opportunities to improve the value of care by increasing quality and decreasing low-value services, the disparities in hospice use and Medicare expenditures by patient BMI provide an excellent opportunity for improvement.” – by Alaina Tedesco

Disclosure: The researchers report primary funding from Robert Wood Johnson Foundation Clinical Scholars Program.