This paper explores the contribution of body-mass index (BMI) categories in shaping past trends of use of healthcare services and associated expenditure in the US and projects results to 2025.
The ...study uses Medical Expenditure Panel Survey (MEPS) data for 2000-2012, reweighted on National Health and Nutrition Survey (NHANES) data for 1972-2012 and US Census Bureau data, to carry out projections for up to 2025. A combination of logistic regressions and generalized linear models was used to model use and associated expenditure for the following healthcare services: inpatient care (with/without surgery), office-based care, outpatient-care, drug prescription and home health care. Quantile regressions were used to analyse and project BMI levels.
20.5 million individuals will be severely obese in 2025. Normal-weight and overweight individuals have stable trends in use for many healthcare services. Conversely, use of healthcare services in patients in class II and class III obesity will increase substantially. Total healthcare expenditure increases more quickly in the obese population than in normal-weight individuals.
Class III obesity (BMI≥40 kg/m2) significantly affects demand and expenditure for all healthcare services. Careful healthcare service planning and implementing effective policy actions to counteract such trends is crucial to meet future demand.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Summary The obesity epidemic is spreading to low-income and middle-income countries as a result of new dietary habits and sedentary ways of life, fuelling chronic diseases and premature mortality. In ...this report we present an assessment of public health strategies designed to tackle behavioural risk factors for chronic diseases that are closely linked with obesity, including aspects of diet and physical inactivity, in Brazil, China, India, Mexico, Russia, and South Africa. England was included for comparative purposes. Several population-based prevention policies can be expected to generate substantial health gains while entirely or largely paying for themselves through future reductions of health-care expenditures. These strategies include health information and communication strategies that improve population awareness about the benefits of healthy eating and physical activity; fiscal measures that increase the price of unhealthy food content or reduce the cost of healthy foods rich in fibre; and regulatory measures that improve nutritional information or restrict the marketing of unhealthy foods to children. A package of measures for the prevention of chronic diseases would deliver substantial health gains, with a very favourable cost-effectiveness profile.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Whether inpatient services can be successfully substituted by office-based services has been debated for many decades, but the evidence is still inconclusive. This study aims to investigate the ...effect of office-based care on use and the expenditure for other healthcare services in patients with type II diabetes (T2D).
A generalized propensity score matching approach was used on pooled Medical Expenditure Panel Survey (MEPS) data for 2000-2012 to explore a dose-response effect. Patients were matched by using a comprehensive set of variables selected following a standard model on access to care.
Office-based care (up to 5 visits/year) acts as a substitute for other healthcare services and is associated with lower use and expenditure for inpatient, outpatient and emergency care. After five visits, office-based care becomes a complement to other services and is associated with increases in expenditure for T2D. Above 20 to 26 visits per year, depending on the healthcare service under consideration, the marginal effect of an additional office-based visit becomes non-statistically significant.
Office-based visits appear to be an effective instrument to reduce use of inpatient care and other services, including outpatient and emergency-care, in patients with T2D without any increase in total healthcare expenditure.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Background In 2008, the world economy entered one of the most severe crises ever. Standards of living fell for large parts of the population in many countries. For example, UK families cut ...their food expenditure by 8·5%. The aim of this study was to assess whether the economic crisis was associated with any dietary change in the UK and other member countries of the Organisation for Economic Co-operation and Development (OECD). Methods A seemingly unrelated regression (SUR) model with random effect estimators was used on a panel dataset that included data between 1999 and 2013 for 21 OECD countries. The dataset included statistics from Euromonitor-Passport, OECD, World Bank, and Eurostat. The three variables of interest were purchase of fruit and vegetables, snack-bars, and snacks. Negative growth in gross domestic product (ie, economic crisis) was the explanatory variable of interest. Foodstuff-specific inflation rates and other key socioeconomic variables (eg, population age) were also included. Compared with standard statistical approaches, SUR models provide more efficient performances when dependent variables can be substituted (eg, fruit and vegetables, snack-bars, and snacks). Findings People living in countries affected by the economic crisis decreased their consumption of fruit and vegetables by 3·64 kg per head per year (95% CI −6·65 to −0·64, p=0·017) which is about one portion per week. At the same time, people slightly increased their consumption of snack-bars (22·6 g per head per year, 95% CI 1·5 to 43·8, p=0·036) and snacks (40·2, −50·5 to 130·9; p=0·385). In the UK, given the levels of consumption of these products, the above mentioned variations indicate that the economic crisis was associated with a 3·5% decrease in purchase of fruit and vegetables and an increased purchase of snack-bars (3·5%) and snacks (0·5%). Interpretation The findings of this study support the hypothesis that tighter food budgets might have led consumers to switch to lower-priced (per calorie) and less healthy food. The economic crisis might have therefore contributed to a further growth in obesity and related chronic diseases. Previous studies suggest that small effects at the population level can mask substantial inequalities across different socioeconomic groups. This study pioneers, in the field of public health, the use of an advanced econometric approach applied to a market information database. Funding This project is partly funded through regular contributions from OECD member countries.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Ageing populations and rising prevalence of non-communicable diseases (NCDs) increasingly contribute to the growing cost burden facing European healthcare systems. Few studies have attempted to ...quantify the future magnitude of this burden at the European level, and none of them consider the impact of potential changes in risk factor trajectories on future health expenditures.
The new microsimulation model forecasts the impact of behavioural and metabolic risk factors on NCDs, longevity and direct healthcare costs, and shows how changes in epidemiological trends can modify those impacts. Economic burden of NCDs is modelled under three scenarios based on assumed future risk factors trends: business as usual (BAU); best case and worst case predictions (BCP and WCP).
The direct costs of NCDs in the EU 27 countries and the UK (in constant 2014 prices) will grow under all scenarios. Between 2014 and 2050, the overall healthcare spending is expected to increase by 0.8% annually under BAU. In the all the countries, 605 billion Euros can be saved by 2050 if BCP is realized compared to the BAU, while excess spending under the WCP is forecast to be around 350 billion. Interpretation: Although the savings realised under the BCP can be substantial, population ageing is a stronger driver of rising total healthcare expenditures in Europe compared to scenario-based changes in risk factor prevalence.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Non-communicable diseases (NCDs) like cancer, cardiovascular disease, and diabetes have spread at a remarkable pace in European countries over the past decades. Overweight/obesity and alcohol use are ...two leading risk factors contributing to both economic and epidemiological burden associated with NCDs. In OECD countries, the impact of indirect costs of obesity varies between 0.20% and 1.21% of GDP. Indirect costs of alcohol use range from 0.19% (Portugal) to 1.6% (Estonia) of GDP.
To assess the longitudinal impact of alcohol use and high body-mass index (BMI) on labour market outcomes in the European region by modeling the direct effect of high BMI and alcohol use, and the effect via associated diseases.
The impact of BMI, alcohol use, and associated diseases on employment likelihood, intent to retire early, days of absenteeism, and hours of work per week, were modelled via lagged Poisson and Zero-inflated Poisson regressions, adjusting for missingness via inverse probability weighting, as appropriate, using European SHARE data.
Controlling for other chronic conditions, being overweight increases employment likelihood among men, but not among women. Obesity decreased female, but not male, employment chances. All chronic conditions linked with high BMI negatively affected employment likelihood, and increased the intention to retire early significantly. Alcohol use positively affects employment likelihood in women at all drinking levels relative to lifetime abstainers, but only in moderate (not heavy) male drinkers. There is super-additionality of impact of NCDs on absenteeism and hours worked, presenting a key economic argument to tackle NCD prevention and compression of morbidity.
NCD prevention is not just important for employment and hours worked, but also for employee morale, especially given increasing retirement age in Europe and globally.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract It is estimated that over half the population of the European Union (EU) is overweight or obese due to an imbalance between energy expenditure and energy intake; this is related to an ...obesogenic environment of sociocultural, economic and marketing challenges to the control of body weight. Excess body fat is associated with nine cancer sites – oesophagus, colorectum, gall bladder, pancreas, postmenopausal breast, endometrium, ovary, kidney and prostate (advanced) – and 4–38% of these cancers (depending on site and gender) can be attributed to overweight/obesity status. Metabolic alterations which accompany excess body weight are accompanied by increased levels of inflammation, insulin, oestrogens and other hormonal factors. There are some indications that intentional weight loss is associated with reduced cancer incidence (notably in postmenopausal breast and endometrial cancers). Excess body weight is also a risk factor for several other diseases, including diabetes and heart disease, and is related to higher risk of premature death. In reviewing the current evidence related to excess body fat and cancer, the European Code against Cancer Nutrition Working Group has developed the following recommendation: ‘Take action to be a healthy body weight’.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To determine clusters of individuals who present similar health behaviors in terms of diet, physical activity, and sedentarism, in four countries of the Americas: Brazil (2013), Chile (2009), Mexico ...(2012), and the United States of America (2013). This makes it possible to determine which of these behaviors occur simultaneously, as well as the demographic and sociodemographic characteristics associated with each cluster.
The individual-level data analyzed were drawn from national health interviews and health examination surveys in Brazil, Chile, Mexico, and the United States, for different time periods. Using international physical activity guidelines and national dietary guidelines, the health behaviors of each individual were assessed. A latent class analysis was conducted to classify individuals into clusters based on these behaviors, and was followed by multinomial regressions to determine the characteristics of those in each class.
Overall, most individuals belonged to the classes characterized by average or unhealthy diets but sufficient amounts of physical activity. However, large differences exist across countries and population groups. Men with higher socioeconomic characteristics were globally more likely to belong to the least healthy class in each country.
Findings from this analysis support the implementation of more refined policy actions to target specific unhealthy behaviors in different population groups, defined by gender, age group, socioeconomic status, and, to some extent, place of residence. The at-risk populations identified through this paper are those that should be targeted by upcoming interventions.
Cancer is a major public health issue. In response, policy‐makers have implemented a range of preventative interventions targeting key risk factors. Using OECD's Strategic Public Health Planning for ...Noncommunicable Diseases model, this article examines the health and economic impact of six primary prevention interventions targeting cancer. Findings can assist decision‐makers efficiently allocate resources to meet public health objectives.
Cancer is a noncommunicable disease (NCD) with increasing incidence and therefore constitutes a major public health issue. To reduce the health and economic burden of cancer, policy‐makers across the world have implemented a range of preventative interventions targeting risk factors with a known link to the disease. In this article, we examine the impact of six primary prevention interventions – related to physical inactivity, unhealthy diet or harmful alcohol use – on cancer‐related health outcomes and healthcare expenditure. Here, we used the OECD Strategic Public Health Planning for NCDs (SPHeP‐NCDs) model to quantify outcomes and costs for each intervention for years 2020–2050 across 37 countries. Results from the model indicate that all interventions could lead to a reduction in the number of new cancer cases, in particular those targeting harmful alcohol consumption. Introducing an alcohol tax, for instance, is estimated to reduce related cancer cases by 5619 a year or 174 193 by 2050. A breakdown of results by type of cancer revealed interventions had the largest impact on colorectal cancer with, on average, 41 140 cases avoided per intervention by 2050. In proportional terms, interventions had the greatest impact on new oesophageal and liver cancers. Findings from this article are designed to assist decision‐makers efficiently allocate limited resources to meet public health objectives.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
The future burden of non-communicable diseases (NCDs) depends on numerous factors such as population ageing, evolution of societal trends, behavioural and physiological risk factors of individuals ...(e.g. smoking, alcohol use, obesity, physical inactivity, and hypertension). This study aims to assess the burden of NCDs in Europe by 2050 under alternative scenarios.
This study combines qualitative and quantitative forecasting techniques to examine how population health in Europe may evolve from 2015 to 2050, taking into account future societal trends. Four scenarios were developed (one business-as-usual scenario, two response scenarios and one pessimistic scenario) and assessed against 'best' and 'worst'-case scenarios. This study provides quantitative estimates of both diseases and mortality outcomes, using a microsimulation model incorporating international survey data.
Each scenario is associated with a different risk factor prevalence rate across Europe during the period 2015-2050. The prevalence and incidence of NCDs consistently increase during the analysed time period, mainly driven by population ageing. In more optimistic scenarios, diseases will appear in later ages, while in the pessimistic scenarios, NCDs will impair working-age people. Life expectancy is expected to grow in all scenarios, but with differences by up to 4 years across scenarios and population groups. Premature mortality from NCDs will be reduced in more optimistic scenarios but stagnate in the worst-case scenario.
Population ageing will have a greater impact on the spread of NCDs by 2050 compared to risk factors. Nevertheless, risk factors, which are influenced by living environments, are an important factor for determining future life expectancy in Europe.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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