Association of body mass index and osteoarthritis with healthcare expenditures and utilization

• Published in: Obesity science & practice Vol. 6; no. 2; pp. 139 - 151
• Main Authors: Johnston, Stephen S., Ammann, Eric, Scamuffa, Robin, Samuels, Jonathan, Stokes, Andrew, Fegelman, Elliott, Hsiao, Chia‐Wen
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.04.2020; John Wiley and Sons Inc; Wiley
• Subjects: Age; Analgesics; Arthritis; Body mass index; Body weight; Confidentiality; Demographics; drug therapy; Electronic medical records; Expenditures; Generalized linear models; Health care policy; healthcare expenditures; healthcare utilization; Hospital costs; Hospitalization; Human subjects; insurance; Insurance claims; Medicare; Morbidity; Narcotics; Obesity; Original; Osteoarthritis; Overweight; Patients; retrospective studies; Studies; telemedicine; Weight control; United States > US; healthcare utilization; healthcare expenditures; body mass index; osteoarthritis
• ISSN: 2055-2238; 2055-2238
• DOI: 10.1002/osp4.398

Summary Objective Osteoarthritis is highly prevalent and, on aggregate, is one of the largest contributors to US spending on hospital‐based health care. This study sought to examine body mass index (BMI)–related variation in the association of osteoarthritis with healthcare utilization and expenditures. Methods This is a retrospective study using administrative insurance claims linked to electronic health records. Study patients were aged ≥ 18 years with ≥1 BMI measurement recorded in 2014, with the first (index) BMI ≥ 25 kg m−2. Study outcomes and covariates were measured during a 1‐year evaluation period spanning 6 months before and after index. Multivariable regression analyses examined the association of BMI with osteoarthritis prevalence, and the combined associations of osteoarthritis and BMI with osteoarthritis‐related medication utilization, all‐cause hospitalization, and healthcare expenditures. Results A total of 256 459 patients (median age = 56 y) met study eligibility criteria; 14.8% (38 050) had osteoarthritis. In multivariable analyses, the adjusted prevalence of osteoarthritis increased with increasing BMI (12.7% in patients who were overweight [25.0‐29.9 kg m−2] to 21.9% in patients with class III obesity [BMI ≥ 40 kg m−2], P < .001). Among patients with osteoarthritis, increasing BMI (from overweight to class III obesity) was associated with increased (all P < .01): utilization rates for analgesic medications (41.5‐53.5%); rates of all‐cause hospitalization (26.3%‐32.0%); and total healthcare expenditures ($18 204‐$23 372). Conclusion The prevalence and economic burden of osteoarthritis grow with increasing BMI; primary prevention of weight‐related osteoarthritis and secondary weight management may help to alleviate this burden.