RTI Health Solutions, Research Triangle Park, NC, USA.
Value Health. 2010 Jun-Jul;13(4):402-10. doi: 10.1111/j.1524-4733.2009.00690.x. Epub 2010 Jan 26.
To estimate the incremental effect of waist circumference (WC) on health-care costs among overweight and obese subjects after adjusting for body mass index (BMI).
A prospective study. The subjects were members of Internet panels in the United States (US) and Germany. 10,816 individuals (United States: n = 5410; Germany: n = 5406) aged 30-70 years with BMI scores between 20 and 35 kg/m(2) were recruited and grouped by category: healthy weight (BMI 20-24.9 kg/m(2)), overweight (BMI 25-29.9 kg/m(2)), and obese (BMI 30-35 kg/m(2)). Within the overweight and obese categories, the individuals were stratified by sex and within those subgroups, characterized as above or below the median WC. The subjects self-reported weight, WC, and health-care resource use at baseline, 3 months, and 6 months using online questionnaires. Over 65% of the recruited subjects completed all surveys. Resource utilization was translated into health-care costs by multiplying unit costs from national sources in each country. Annualized health costs were summarized for subjects with low and high WC within the overweight and obese categories. A two-part model generated predicted annual costs because of the WC difference controlling for BMI, demographic, and lifestyle variables among the overweight and obese subjects.
When BMI and other characteristics are constant, annual health-care costs are 16% to 18% higher in Germany and 20% to 30% higher in the United States for the subjects with a high WC compared with subjects with a low WC.
Targeting people with a high waist circumference for weight management whether they are overweight or obese may maximize cost-efficacy.
在调整体重指数（BMI）后，估计腰围（WC）对超重和肥胖患者医疗保健费用的增量影响。
前瞻性研究。研究对象为美国（美国）和德国互联网小组的成员。共招募了 10816 名年龄在 30-70 岁之间、BMI 评分在 20-35 kg/m²之间的个体，分为健康体重（BMI 20-24.9 kg/m²）、超重（BMI 25-29.9 kg/m²）和肥胖（BMI 30-35 kg/m²）三组。在超重和肥胖组内，根据性别分层，并在这些亚组内，根据 WC 的中位数分为高于或低于中位数。参与者使用在线问卷在基线、3 个月和 6 个月时自我报告体重、WC 和医疗资源使用情况。超过 65%的招募参与者完成了所有调查。利用各国国家资源的单位成本将资源利用转化为医疗保健成本。对超重和肥胖人群中 WC 较高和较低的受试者进行了年度医疗费用总结。在超重和肥胖人群中，使用双部分模型生成了由于 WC 差异而导致的预测年度费用，该模型控制了 BMI、人口统计学和生活方式变量。
当 BMI 和其他特征保持不变时，与 WC 较低的受试者相比，德国受试者的年度医疗保健费用高出 16%-18%，美国受试者的年度医疗保健费用高出 20%-30%。
无论超重或肥胖，针对 WC 较高的人群进行体重管理可能会最大限度地提高成本效益。
