Clarke Erin D, Baldwin Jennifer N, Ashton Lee M, Burrows Tracy L, Hure Alexis, Loxton Deborah, Patterson Amanda J, Collins Clare E
School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton, New South Wales, Australia.
Hunter Medical Research Institute, New Lambton, New South Wales, Australia; The University of Newcastle Priority Research Centre for Generational Health and Ageing, New Lambton, New South Wales, Australia; The University of Newcastle School of Medicine and Public Health, Callaghan, New South Wales, Australia.
J Acad Nutr Diet. 2025 Apr;125(4):472-485.e5. doi: 10.1016/j.jand.2024.09.009. Epub 2024 Sep 23.
The relationships between diet quality and health care costs have not been explored beyond 15 years.
To investigate relationships between both baseline diet quality and change in diet quality over time with cumulative data on health care claims and costs over 21 years among Australian women.
This is a secondary analysis of data from a cohort study, the Australian Longitudinal Study on Women's Health.
PARTICIPANTS/SETTING: Data for women born between 1946 and 1951 included diet quality data at baseline (2001, n = 8228), change in diet quality (2001-2013, n = 6553), and cumulative administrative health care data (2001-2021).
Diet quality was assessed using the Australian Recommended Food Score (ARFS) and the Fruit and Vegetable Variety Score. Twenty-one-year cumulative Medicare Benefits Schedule data (number of claims; total charges [$USD]), Australia's universal health care coverage, were reported by baseline ARFS quintile and category of diet quality change ("diet quality worsened" [ARFS decrease ≤ -4 points], "remained stable" [-3 ≤ change in ARFS ≤ 3 points] or "improved" [ARFS increase ≥ 4 points]).
Linear regression analyses were conducted and adjusted for socioeconomic, health, and lifestyle factors.
Higher baseline vegetable ARFS were correlated with fewer 21-year cumulative Medicare claims (β = -4.9, 95% CI, -7.3, -2.4) and charges (β = -$214; 95% CI, -$341; -$88). Baseline higher dairy scores were correlated with higher Medicare claims (β = 17.2; 95% CI, 11.1, 23.3) and charges (β = $762; 95% CI, $448, $1076). Compared with women whose diet quality score remained stable, those whose diet quality worsened over time made significantly more claims and higher charges; median (Q1, Q3) 413 (277, 588) claims, $17 868 ($11 037, $27 808) cumulative charges, compared with 387 (259, 559) claims, and $16 953 ($10 033, $26 604) cumulative charges. Change in total ARFS and ARFS subscales were predictors of 21-year cumulative health care claims. For each 1-point increase in ARFS over time, 1.2 fewer health care claims were made (95% CI, 0.3-2.2). Increasing vegetable and dairy ARFS scores were correlated with significantly fewer claims.
Baseline greater variety of vegetables was correlated with fewer 21-year health care claims and costs. Worsening diet quality over time was correlated with greater cumulative health care claims and costs. Consideration of dietary quality and variety in national policy is suggested to potentially reduce national health care claims and costs.
饮食质量与医疗保健成本之间的关系在超过15年的时间跨度内尚未得到探讨。
利用澳大利亚女性21年的医疗保健索赔和成本累积数据，研究基线饮食质量以及饮食质量随时间的变化与这些数据之间的关系。
这是一项对队列研究（澳大利亚女性健康纵向研究）数据的二次分析。
参与者/研究背景：1946年至1951年出生女性的数据包括基线时（2001年，n = 8228）的饮食质量数据、饮食质量变化（2001 - 2013年，n = 6553）以及累积的行政医疗保健数据（2001 - 2021年）。
使用澳大利亚推荐食物评分（ARFS）和果蔬品种评分评估饮食质量。按基线ARFS五分位数和饮食质量变化类别（“饮食质量恶化”[ARFS降低≤ -4分]、“保持稳定”[-3≤ARFS变化≤3分]或“改善”[ARFS增加≥4分]）报告21年累积的医疗保险福利计划数据（索赔数量；总费用[美元]），澳大利亚全民医保覆盖范围。
进行线性回归分析，并对社会经济、健康和生活方式因素进行调整。
较高的基线蔬菜ARFS与较少的21年累积医疗保险索赔（β = -4.9，95%CI，-7.3，-2.4）和费用（β = -214美元；95%CI，-341美元；-88美元）相关。基线较高的乳制品评分与较高的医疗保险索赔（β = 17.2；95%CI，11.1，23.3）和费用（β = 762美元；95%CI，448美元，1076美元）相关。与饮食质量评分保持稳定的女性相比，那些饮食质量随时间恶化的女性提出的索赔显著更多且费用更高；中位数（Q1，Q3）为413（277，588）次索赔，累积费用17868美元（11037美元，27808美元），而保持稳定的女性为387（259，559）次索赔，累积费用16953美元（10033美元，26604美元）。总ARFS及其子量表的变化是21年累积医疗保健索赔的预测因素。随着时间推移，ARFS每增加1分，医疗保健索赔减少1.2次（95%CI，0.3 - 2.2）。蔬菜和乳制品ARFS评分增加与索赔显著减少相关。
基线时蔬菜种类更多与较少的21年医疗保健索赔和成本相关。饮食质量随时间恶化与更高的累积医疗保健索赔和成本相关。建议在国家政策中考虑饮食质量和种类，以潜在地降低国家医疗保健索赔和成本。
