Levitan Emily B, Zhu Aowen, Bittner Vera, Brown Todd M, Farkouh Michael E, Girguis Mariam, Huang Lei, Jackson Elizabeth A, Judd Suzanne E, Rhodes Shannon, Safford Monika M, Strande Jennifer L, Wang Min-Jung, Woodward Mark, Long D Leann
Department of Epidemiology University of Alabama at Birmingham Birmingham AL USA.
Division of Cardiovascular Disease University of Alabama at Birmingham Birmingham AL USA.
J Am Heart Assoc. 2025 Apr;14(7):e037034. doi: 10.1161/JAHA.124.037034. Epub 2025 Mar 21.
Individuals with obesity have more ambulatory care usage than individuals with normal weight and overweight. There is limited information on whether this is consistent across provider specialties and whether comorbidities explain the associations.
Among REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort study participants with Medicare fee-for-service coverage (n=9648), we identified ambulatory visits over 5 years. We used marginalized zero-inflated Poisson models to calculate ratios of means by body mass index (BMI), adjusted for demographics and health behaviors, and inverse odds weighting to evaluate mediation by diabetes, hypertension, dyslipidemia, stroke, coronary heart disease, atrial fibrillation, heart failure, chronic kidney disease, depressive symptoms, cancer, arthritis, and sleep apnea. The mean age of participants was 71.7±7.3 years, 35.1% were Black individuals and 64.9% White individuals, and 51.1% were women. Participants had a mean of 37.8 total, 16.0 primary care, 3.4 cardiology, 1.9 orthopedics, 0.9 pulmonology, and 0.4 endocrinology visits. Compared with individuals with BMI 18.5 to <25 kg/m (n=2613), participants with BMI ≥35 kg/m (n=1259) had 23% (95% CI, 21%-24%) more ambulatory visits. Participants with BMI ≥35 kg/m had 26% more primary care, 20% more cardiology, 74% more orthopedics, 62% more pulmonology, and 85% more endocrinology visits. Comorbidities partly explained associations with overall, primary care, and orthopedics visits (39%, 38%, and 15%, respectively) and largely explained associations with cardiology, pulmonology, and endocrinology visits.
Understanding which specialty visits are associated with higher BMI can help with workforce planning and allocation of resources.
肥胖个体比正常体重和超重个体的门诊医疗使用量更多。关于这在不同医疗服务专业中是否一致以及合并症是否能解释这种关联的信息有限。
在有医疗保险按服务付费覆盖的REGARDS（卒中地理和种族差异原因）队列研究参与者中（n = 9648），我们确定了5年期间的门诊就诊情况。我们使用边际零膨胀泊松模型来计算按体重指数（BMI）调整人口统计学和健康行为后的均值比，并使用逆概率加权法来评估糖尿病、高血压、血脂异常、卒中、冠心病、心房颤动、心力衰竭、慢性肾病、抑郁症状、癌症、关节炎和睡眠呼吸暂停的中介作用。参与者的平均年龄为71.7±7.3岁，35.1%为黑人个体，64.9%为白人个体，51.1%为女性。参与者的门诊就诊总均值为37.8次，初级保健就诊均值为16.0次，心脏病学就诊均值为3.4次，骨科就诊均值为1.9次，肺病学就诊均值为0.9次，内分泌学就诊均值为0.4次。与BMI为18.5至<25 kg/m的个体（n = 2613）相比，BMI≥35 kg/m的参与者（n = 1259）的门诊就诊次数多23%（95%CI，21% - 24%）。BMI≥35 kg/m的参与者的初级保健就诊次数多26%，心脏病学就诊次数多20%，骨科就诊次数多74%，肺病学就诊次数多62%，内分泌学就诊次数多85%。合并症部分解释了与总体、初级保健和骨科就诊的关联（分别为39%、38%和15%），并在很大程度上解释了与心脏病学、肺病学和内分泌学就诊的关联。
了解哪些专业就诊与较高的BMI相关有助于劳动力规划和资源分配。
