Nishikawa Kunihito, Yamamoto Masayuki
Center of Medical Check-up, Shinko Hospital.
Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health.
J Epidemiol. 2020 May 5;30(5):201-207. doi: 10.2188/jea.JE20180268. Epub 2019 Apr 13.
The combined associations of body mass index (BMI) levels and metabolic dysfunction with medical and dental care utilizations is unclear.
A 4-year follow-up study was performed in 16,386 Japanese male employees (mean age 48.2 [standard deviation, 11.0] years) without a history of cardiovascular disease (CVD), cancer, or renal failure. They were classified into eight phenotypes based on four BMI levels (underweight, <18.5; normal weight, 18.5-24.9; overweight, 25.0-29.9; and obese, ≥30.0 kg/m) and the presence or absence of ≥2 of 4 metabolic abnormalities: high blood pressure, high triglycerides, low high-density-lipoprotein cholesterol, and high blood sugar. Based on their health insurance claims data, we compared medical and dental care days and costs among the eight different BMI/metabolic phenotypes during 2010-2013.
The combinations of BMI levels and metabolic status were significantly associated with the adjusted mean and median medical outpatient days and costs and the median dental outpatient days and costs. The obese/unhealthy subjects had the highest medical outpatient days and costs, and the underweight/unhealthy subjects had the highest dental outpatient days and costs. The underweight/unhealthy subjects also had the highest medical inpatient days and hospitalization rates of CVD, and had higher medical costs compared with the obese/healthy subjects. The differences in median medical costs between healthy and unhealthy phenotypes were larger year by year across all BMI levels.
Identification of obesity phenotypes using both BMI levels (including the underweight level) and metabolic status may more precisely predict healthcare days and costs compared with either BMI or metabolic status alone.
体重指数（BMI）水平与代谢功能障碍与医疗和牙科护理利用之间的联合关联尚不清楚。
对16386名无心血管疾病（CVD）、癌症或肾衰竭病史的日本男性员工（平均年龄48.2[标准差，11.0]岁）进行了为期4年的随访研究。根据四个BMI水平（体重过轻，<18.5；正常体重，18.5 - 24.9；超重，25.0 - 29.9；肥胖，≥30.0 kg/m²）以及4种代谢异常（高血压、高甘油三酯、低高密度脂蛋白胆固醇和高血糖）中是否存在≥2种情况，将他们分为8种表型。基于他们的健康保险理赔数据，我们比较了2010 - 2013年期间8种不同BMI/代谢表型之间的医疗和牙科护理天数及费用。
BMI水平与代谢状态的组合与调整后的平均和中位数医疗门诊天数及费用以及中位数牙科门诊天数及费用显著相关。肥胖/不健康的受试者医疗门诊天数和费用最高，体重过轻/不健康的受试者牙科门诊天数和费用最高。体重过轻/不健康的受试者CVD的医疗住院天数和住院率也最高，与肥胖/健康的受试者相比，医疗费用更高。在所有BMI水平上，健康和不健康表型之间的中位数医疗费用差异逐年增大。
与单独使用BMI或代谢状态相比，同时使用BMI水平（包括体重过轻水平）和代谢状态来识别肥胖表型可能更精确地预测医疗护理天数和费用。
