Merrill Ray M, Fowers Rylan
Department of Public Health, Brigham Young University, Provo, Utah, USA.
BMJ Open. 2019 May 28;9(5):e024078. doi: 10.1136/bmjopen-2018-024078.
To identify the extent that sex, age and body mass index (BMI) is associated with medical and pharmacy costs.
Retrospective cohort.
A school district in the Western USA involving 2531 workers continuously employed during 2011-2014.
Medical and pharmacy costs and BMI.
Approximately 84% of employees participated in wellness screening. Participants were 1.03 (95% CI 1.01 to 1.06) times more likely to be women and younger (M=47.8 vs 49.8, p<0.001). Median medical and pharmacy costs were higher for women than men, increased with age, and were greater in morbidly obese individuals (p<0.001). Annual pharmacy claims were 18% more likely to be filed by women than men, 23% more likely filed by those aged ≥60 versus <40 years, and 6% more likely filed by morbidly obese individuals than of normal weight (p<0.001) individuals. Greater medical and pharmacy costs in older age were most pronounced in underweight and morbidly obese groups. Higher use of medication among women than men was primarily because of drugs involving birth control, osteoporosis, thyroid disease and urinary tract infection. Higher medication use in older age was primarily related to medications used to treat gastrointestinal problems. Medication use was positively associated with BMI weight classifications for most of the 33 drug types considered, with exceptions involving birth control, herpes and osteoporosis. A J-shape relationship was observed between BMI and medication use for acne, antibiotic, cold/influenza/allergy, eye infection, oedema, muscle spasms, pain and ulcers.
Medications associated with higher medical and pharmacy costs among women, older age and underweight or obese individuals are identified. Lowering medical and pharmacy costs requires weight management in older ages, particularly for underweight and obese. Higher pharmacy costs for certain drugs among underweight individuals may be associated with poorer nutrition.
确定性别、年龄和体重指数（BMI）与医疗和药品费用之间的关联程度。
回顾性队列研究。
美国西部一个学区，涉及2011 - 2014年期间持续受雇的2531名员工。
医疗和药品费用以及BMI。
约84%的员工参加了健康筛查。参与者中女性和年轻人的比例比非参与者高1.03倍（95%置信区间为1.01至1.06）（平均年龄分别为47.8岁和49.8岁，p<0.001）。女性的医疗和药品费用中位数高于男性，随年龄增长而增加，且在病态肥胖个体中更高（p<0.001）。女性每年提交药品报销申请的可能性比男性高18%，60岁及以上人群比40岁以下人群高23%，病态肥胖个体比正常体重个体高6%（p<0.001）。年龄较大者较高的医疗和药品费用在体重过轻和病态肥胖组中最为明显。女性用药量高于男性主要是因为涉及避孕药、骨质疏松症、甲状腺疾病和尿路感染的药物。年龄较大者用药量较高主要与用于治疗胃肠道问题的药物有关。在所考虑的33种药物类型中，大多数药物的用药量与BMI体重分类呈正相关，但避孕药、疱疹药和骨质疏松症药物除外。在痤疮、抗生素、感冒/流感/过敏、眼部感染、水肿、肌肉痉挛、疼痛和溃疡的用药方面，观察到BMI与用药之间呈J形关系。
确定了与女性、年龄较大者以及体重过轻或肥胖个体较高医疗和药品费用相关的药物。降低医疗和药品费用需要在老年人中进行体重管理，特别是体重过轻和肥胖者。体重过轻个体某些药物的药品费用较高可能与营养较差有关。
Zotero 插件