Wolf A M, Colditz G A
The Women's Place, University of Virginia Health Systems, Charlottesville, USA.
Obes Res. 1998 Mar;6(2):97-106. doi: 10.1002/j.1550-8528.1998.tb00322.x.
This study was undertaken to update and revise the estimate of the economic impact of obesity in the United States. A prevalence-based approach to the cost of illness was used to estimate the economic costs in 1995 dollars attributable to obesity for type 2 diabetes mellitus, coronary heart disease (CHD), hypertension, gallbladder disease, breast, endometrial and colon cancer, and osteoarthritis. Additionally and independently, excess physician visits, work-lost days, restricted activity, and bed-days attributable to obesity were analyzed cross-sectionally using the 1988 and 1994 National Health Interview Survey (NHIS). Direct (personal health care, hospital care, physician services, allied health services, and medications) and indirect costs (lost output as a result of a reduction or cessation of productivity due to morbidity or mortality) are from published reports and inflated to 1995 dollars using the medical component of the consumer price index (CPI) for direct cost and the all-items CPI for indirect cost. Population-attributable risk percents (PAR%) are estimated from large prospective studies. Excess work-lost days, restricted activity, bed-days, and physician visits are estimated from 88,262 U.S. citizens who participated in the 1988 NHIS and 80,261 who participated in the 1994 NHIS. Sample weights have been incorporated into the NHIS analyses, making these data generalizable to the U.S. population. The total cost attributable to obesity amounted to $99.2 billion dollars in 1995. Approximately $51.64 billion of those dollars were direct medical costs. Using the 1994 NHIS data, cost of lost productivity attributed to obesity (BMI> or =30) was $3.9 billion and reflected 39.2 million days of lost work. In addition, 239 million restricted-activity days, 89.5 million bed-days, and 62.6 million physician visits were attributable to obesity in 1994. Compared with 1988 NHIS data, in 1994 the number of restricted-activity days (36%), bed-days (28%), and work-lost days (50%) increased substantially. The number of physician visits attributed to obesity increased 88% from 1988 to 1994. The economic and personal health costs of overweight and obesity are enormous and compromise the health of the United States. The direct costs associated with obesity represent 5.7% of our National Health Expenditure in the United States.
开展这项研究是为了更新和修订对美国肥胖症经济影响的估计。采用基于患病率的疾病成本计算方法，以1995年美元价值估算肥胖症导致的2型糖尿病、冠心病（CHD）、高血压、胆囊疾病、乳腺癌、子宫内膜癌和结肠癌以及骨关节炎的经济成本。此外，还独立地使用1988年和1994年的美国国家健康访谈调查（NHIS）对肥胖症导致的额外就诊次数、误工天数、活动受限天数和卧床天数进行了横断面分析。直接成本（个人医疗保健、医院护理、医生服务、专职医疗服务和药物）和间接成本（由于发病或死亡导致生产力下降或停止而造成的产出损失）来自已发表的报告，并分别使用消费者价格指数（CPI）的医疗组成部分将直接成本和所有项目的CPI将间接成本换算为1995年美元价值。人群归因风险百分比（PAR%）根据大型前瞻性研究估算得出。额外的误工天数、活动受限天数、卧床天数和就诊次数是根据88262名参与1988年NHIS的美国公民和80261名参与1994年NHIS的美国公民估算得出。样本权重已纳入NHIS分析中，使这些数据能够推广至美国人群。1995年，肥胖症导致的总成本达992亿美元。其中约516.4亿美元为直接医疗成本。根据1994年NHIS数据，肥胖症（BMI≥30）导致的生产力损失成本为39亿美元，反映出3920万个误工日。此外，1994年有2.39亿个活动受限日、8950万个卧床日和6260万次就诊归因于肥胖症。与1988年NHIS数据相比，1994年活动受限天数（36%）、卧床天数（28%）和误工天数（50%）大幅增加。1988年至1994年，肥胖症导致的就诊次数增加了88%。超重和肥胖症的经济和个人健康成本巨大，损害了美国民众的健康。与肥胖症相关的直接成本占美国国家卫生支出的5.7%。
