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

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  • Padraig Dixon

    (University of Bristol
    University of Bristol)

  • George Davey Smith

    (University of Bristol
    University of Bristol
    University of Bristol)

  • William Hollingworth

    (University of Bristol)

Abstract

Background High 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. Methods We 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 of adiposity, and average adjusted predicted costs of adiposity. Results Valid 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–£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–£73.42). The marginal effect of becoming obese was £136.35 (99% confidence interval £124.62–£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. Conclusions Higher 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.

Suggested Citation

  • Padraig Dixon & George Davey Smith & William Hollingworth, 2019. "The Association Between Adiposity and Inpatient Hospital Costs in the UK Biobank Cohort," Applied Health Economics and Health Policy, Springer, vol. 17(3), pages 359-370, June.
    • Handle: RePEc:spr:aphecp:v:17:y:2019:i:3:d:10.1007_s40258-018-0450-2
    DOI: 10.1007/s40258-018-0450-2
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    References listed on IDEAS

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    1. John Cawley & Chad Meyerhoefer & Adam Biener & Mette Hammer & Neil Wintfeld, 2015. "Savings in Medical Expenditures Associated with Reductions in Body Mass Index Among US Adults with Obesity, by Diabetes Status," PharmacoEconomics, Springer, vol. 33(7), pages 707-722, July.
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    1. Hazewinkel, Audinga-Dea & Richmond, Rebecca C. & Wade, Kaitlin H. & Dixon, Padraig, 2022. "Mendelian randomization analysis of the causal impact of body mass index and waist-hip ratio on rates of hospital admission," Economics & Human Biology, Elsevier, vol. 44(C).
    2. Jiwoo Lee & Sakari Jukarainen & Antti Karvanen & Padraig Dixon & Neil M. Davies & George Davey Smith & Pradeep Natarajan & Andrea Ganna, 2023. "Quantifying the causal impact of biological risk factors on healthcare costs," Nature Communications, Nature, vol. 14(1), pages 1-11, December.

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