comorbidities, health care use, health care costs, and health behaviors by bmi suzanne m. goodwin...
TRANSCRIPT
Comorbidities, Health Care Use, Health Care Costs, and
Health Behaviors by BMI
Suzanne M. GoodwinDoctoral Candidate
Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public Health
AcademyHealth Annual Research MeetingJune 10, 2008
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Obesity in the U.S.
• 34% of adults in U.S. are obese (BMI≥30 kg/m2)
• Obese persons generally have more comorbidities and higher health care costs and utilization than nonobese
3
JHU-BCBS Patterns of Obesity Care Study
• Partnership with Johns Hopkins University, Blue Cross Blue Shield Association, and 7 BCBS plans
• Evaluate health care utilization, cost and obesity treatment outcomes among 7 BCBS plans
• 2002-5 claims data on selected plan enrollees
– Health Risk Assessment data from 3 plans
4
Study Purpose
• To assess the association between BMI and comorbidities, health care utilization, health care costs and health behaviors among a large cohort of individuals enrolled in 3 BCBS plans
*** Preliminary results – work in progress ***
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Study Sample• 71,058 unique HRA respondents
– 56% female
– Mean age: 48.8 years
• Exclusions
– Missing height or weight
– 10<BMI<70
– Age <18
– Pregnancy within 1 year of HRA completion year
– <6 months plan enrollment in HRA completion year
– Extra HRA records for same person
– Bariatric surgery patients
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Study Data• Members’ HRA data combined with their claims data for
same year
• HRA data
– Height and weight to calculate BMI
– Self-reported health behaviors (e.g., smoking, alcohol use,
exercise)
• Claims data
– ICD and CPT codes
– Paid costs
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BMI DistributionUnderweight2%
Morbidly Obese3%
Normal40%
Overweight35%
Obese20% Underweight
Normal
Overweight
Obese
Morbidly Obese
Mean BMI = 26.7
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Comorbidities by BMI
0%
5%
10%
15%
20%
25%
30%
35%
40%
0
2
4
6
8
10
12
14
16
Normal Overwt Obese Morbid obese
Overwt OR Obese OR Morbid obese OR
Pre
vale
nc
e
Od
ds
Rat
io
Ref: normal
adjusted for sex, age, plan site, and plan type
* p<0.05
*
*
*
*
*
** * *
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Comorbidities by BMI
0%
3%
6%
9%
12%
15%
Cardiaccondition
Asthma Sleepapnea
Cardiaccondition
Asthma Sleepapnea
0
5
10
15
20
25
Normal Overwt Obese Morbid obese
Overwt OR Obese OR Morbid obese OR
Pre
vale
nc
e
Od
ds
Rat
io
Ref: normal
adjusted for sex, age, plan site, and plan type
* p<0.05**
*
*
*
** * *
10
Hospital Stay by BMI
0%
2%
4%
6%
8%
10%
1+ hospital stay 1+ hospital stay OR
0
0.3
0.6
0.9
1.2
1.5
Normal Overwt Obese Morbid obese
Overwt OR Obese OR Morbid obese OR
Od
ds
Rat
io
Ref: normal
adjusted for sex, age, plan site, plan type, and 6 comorbidities
* p<0.05
**
*
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Health Care Costs by BMI
$0
$1,000
$2,000
$3,000
$4,000
TOTAL Hospital Prof Rx
Normal Overweight Obese Morbidly Obese
Sta
nd
ard
ize
d M
ean
Co
sts
b
ase
d o
n R
VU
s
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Health Behaviors by BMI
0%
10%
20%
30%
40%
50%
Exercise (N=32,147) Smoking (N=22,444) Alcohol (N=44,473)
Normal Overweight Obese Morbidly Obese
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Health Behaviors by BMI
0.25
0.50
0.75
1.00
1.25
1.50
Overweight Obese Morbidly Obese
Ref: normal
Adjusted for sex, age, plan site, and plan type
* p<.05
**
*
*
**
*
Od
ds
Rat
io Exercise Smoking
Alcohol
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Strengths and Limitations
• Largest and most current database that has been used for this type of study
• HRA data
– Self-reported height, weight and health behaviors
– Survey instruments
• Claims data
– Unreported comorbidities and health care services
• Single BMI measurement, one year of claims data
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Conclusions
• Obese more likely to have comorbidity, be hospitalized, have higher health care costs, and engage in unhealthy behaviors
• Findings will help:
– Health plans better understand how obesity is affecting
their members' health and use of health care resources as
well as the impact of obesity on their costs
– Providers, health plans, and employers identify which
conditions to focus on for disease prevention and
management programs
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Acknowledgements• Johns Hopkins University – Jonathan Weiner, Jeanne
Clark, Hsien-Yen Chang, Tom Richards, Andrew Shore, Shari Bolen
• BCBS Association – John Newman, Greg Wozniak, Nadine Caputo, Mary Madison
• BCBS plans – BCBS of Tennessee, BCBS of Hawaii, BCBS of North Carolina, BCBS of Michigan, Independence Blue Cross, Highmark, Wellmark
• Funders – J&J Ethicon Endo-Surgery, Pfizer, GlaxoSmithKline