Thorpe Kenneth E, Joski Peter J
Department of Health Policy and Management, Rollins School of Public, Health Emory University, Atlanta, Georgia.
JAMA Netw Open. 2024 Dec 2;7(12):e2449200. doi: 10.1001/jamanetworkopen.2024.49200.
Recent data from federal surveys show that more than 70% of adults have either overweight or obesity. Overweight and obesity are associated with several expensive chronic conditions, such as type 2 diabetes, heart disease, hypertension, and hyperlipidemia. The prevalence of chronic disease is a key driver of rising health care spending among employers and the Medicare program.
To estimate health care spending among adults with overweight or obesity and have employer-sponsored insurance or Medicare and examine the association of higher and lower body mass index (BMI).
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included privately insured adults and adult Medicare beneficiaries with a BMI of 25 and higher. Data from the Medical Expenditure Panel Survey-Household Component were used to tabulate total annual health care spending. Data were analyzed from April 1 to June 20, 2024.
The primary intended measures were total annual health care spending, controlling for patient demographics, income, education, and BMI. The baseline health care spending as a percentage reduction in BMI. An instrumental variable regression model with estimated total spending at various levels of BMI was used.
This study included 3774 adults who were insured with Medicare (mean [SD] age, 63.1 [11.1] years; mean [SD] percentage female, 50.4% [49.7%]; mean [SD] percentage non-Hispanic Black adults, 17.4% [37.7%]; mean [SD] percentage non-Hispanic White adults, 61.3% [48.4%]). The study also included 13 435 adults who had employer-sponsored insurance (mean [SD] age, 46.3 [6.9] years; mean [SD] percentage female, 47.6% [48.9%]; mean [SD] percentage non-Hispanic Black adults, 11.1% [30.7%]; mean [SD] percentage non-Hispanic White adults, 73.1% [43.4%]). Overall, adults with employer-sponsored insurance with a weight loss of 5% were estimated to spend a mean of $670 (95% CI, $654-$686) less on health care (8% less), and those with a weight loss of 25% spent an estimated mean of $2849 (95% CI, $2783-$2916) less on health care (34% less). Among adults with Medicare who had 1 or more comorbid conditions, a 5% weight loss was estimated to reduce spending by $1262 (95% CI, $1217-$1306) (7% less) and a 25% weight loss was estimated to reduce health care spending by a mean of $5442 (95% CI, $5254-$5629) (31% less).
In this cross-sectional study, projected annual savings from weight loss among US adults with obesity were substantial for both Medicare and employer-based insurance.
联邦调查的最新数据显示，超过70%的成年人超重或肥胖。超重和肥胖与多种昂贵的慢性病相关，如2型糖尿病、心脏病、高血压和高脂血症。慢性病的流行是雇主和医疗保险计划中医疗保健支出上升的关键驱动因素。
估计超重或肥胖且拥有雇主赞助保险或医疗保险的成年人的医疗保健支出，并研究较高和较低体重指数（BMI）之间的关联。
设计、设置和参与者：这项横断面研究纳入了BMI为25及以上的私人保险成年人和成年医疗保险受益人。医疗支出面板调查-家庭部分的数据用于统计年度医疗保健总支出。数据于2024年4月1日至6月20日进行分析。
主要预期指标是年度医疗保健总支出，控制患者人口统计学、收入、教育和BMI。基线医疗保健支出以BMI降低的百分比表示。使用了具有不同BMI水平估计总支出的工具变量回归模型。
本研究包括3774名参加医疗保险的成年人（平均[标准差]年龄，63.1[11.1]岁；平均[标准差]女性百分比，50.4%[49.7%]；平均[标准差]非西班牙裔黑人成年人百分比，17.4%[37.7%]；平均[标准差]非西班牙裔白人成年人百分比，61.3%[48.4%]）。该研究还包括13435名拥有雇主赞助保险的成年人（平均[标准差]年龄，46.3[6.9]岁；平均[标准差]女性百分比，47.6%[48.9%]；平均[标准差]非西班牙裔黑人成年人百分比，11.1%[30.7%]；平均[标准差]非西班牙裔白人成年人百分比，73.1%[43.4%]）。总体而言，体重减轻5%的拥有雇主赞助保险的成年人估计医疗保健支出平均减少670美元（95%置信区间，654 - 686美元）（减少8%），体重减轻25%的成年人估计医疗保健支出平均减少2849美元（95%置信区间，2783 - 2916美元）（减少34%）。在患有1种或更多合并症的医疗保险成年人中，体重减轻5%估计可使支出减少1262美元（95%置信区间，1217 - 1306美元）（减少7%），体重减轻25%估计可使医疗保健支出平均减少5442美元（95%置信区间，5254 - 5629美元）（减少31%）。
在这项横断面研究中，美国肥胖成年人通过减肥预计每年节省的费用对于医疗保险和基于雇主的保险而言都相当可观。
