Okamura Tomonori, Nakamura Koshi, Kanda Hideyuki, Hayakawa Takehito, Hozawa Atsushi, Murakami Yoshitaka, Kadowaki Takashi, Kita Yoshikuni, Okayama Akira, Ueshima Hirotsugu
Department of Health Science, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu 520-2192, Japan.
Circ J. 2007 Jun;71(6):807-13. doi: 10.1253/circj.71.807.
Although obesity is required for some criteria defining metabolic syndrome, clustering of other risk factors also indicates an increased risk of cardiovascular disease. Whether the relationship between cardiovascular risk factor clustering and medical expenditures differs with body mass index (BMI) requires investigation, especially in a population with a low prevalence of obesity such as that in Japan.
A 10-year cohort study of 4,478 Japanese National Health Insurance beneficiaries aged 40-69 years in a community between 1990 and 2001 was carried out in the present study. The clustering of cardiovascular risk factors showed a positive and graded relationship to personal medical expenditures in participants who are overweight (BMI > or =25.0) and normal weight (BMI <25.0). The individual medical expenditures per month were 1.7-fold higher for participants with 2 or 3 risk factors and overweight than for those without these factors (26,782 vs 15,377 Japanese yen). Differences in the geometric means were similarly significant after adjustment for other confounding factors. However, the excess medical expenditures by risk clustering of normal weight categories within the total medical expenditures were higher than those of overweight categories because more participants were of normal weight.
Cardiovascular risk factor clustering and being overweight can be a useful predictor of medical expenditures in a Japanese population.
尽管肥胖是代谢综合征某些定义标准所必需的，但其他危险因素的聚集也表明心血管疾病风险增加。心血管危险因素聚集与医疗支出之间的关系是否因体重指数（BMI）而异，这需要进行研究，尤其是在肥胖患病率较低的人群中，如日本人群。
本研究对1990年至2001年间在一个社区的4478名年龄在40 - 69岁的日本国民健康保险受益人群进行了为期10年的队列研究。在超重（BMI≥25.0）和体重正常（BMI<25.0）的参与者中，心血管危险因素的聚集与个人医疗支出呈正相关且呈分级关系。有2种或3种危险因素且超重的参与者每月的个人医疗支出比没有这些因素的参与者高出1.7倍（26,782日元对15,377日元）。在调整其他混杂因素后，几何均值的差异同样显著。然而，由于体重正常的参与者更多，在总医疗支出中体重正常类别因危险因素聚集导致的额外医疗支出高于超重类别。
在日本人群中，心血管危险因素聚集和超重可能是医疗支出的有用预测指标。
