Comorbidities, Health Care Use, Health Care Costs, and Health Behaviors by BMI Suzanne M. Goodwin...

Comorbidities, Health Care Use, Health Care Costs, and

Health Behaviors by BMI

Suzanne M. GoodwinDoctoral Candidate

Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public Health

sgoodwin@jhsph.edu

AcademyHealth Annual Research MeetingJune 10, 2008

2

Obesity in the U.S.

• 34% of adults in U.S. are obese (BMI≥30 kg/m2)

• Obese persons generally have more comorbidities and higher health care costs and utilization than nonobese

3

JHU-BCBS Patterns of Obesity Care Study

• Partnership with Johns Hopkins University, Blue Cross Blue Shield Association, and 7 BCBS plans

• Evaluate health care utilization, cost and obesity treatment outcomes among 7 BCBS plans

• 2002-5 claims data on selected plan enrollees

– Health Risk Assessment data from 3 plans

4

Study Purpose

• To assess the association between BMI and comorbidities, health care utilization, health care costs and health behaviors among a large cohort of individuals enrolled in 3 BCBS plans

*** Preliminary results – work in progress ***

5

Study Sample• 71,058 unique HRA respondents

– 56% female

– Mean age: 48.8 years

• Exclusions

– Missing height or weight

– 10<BMI<70

– Age <18

– Pregnancy within 1 year of HRA completion year

– <6 months plan enrollment in HRA completion year

– Extra HRA records for same person

– Bariatric surgery patients

6

Study Data• Members’ HRA data combined with their claims data for

same year

• HRA data

– Height and weight to calculate BMI

– Self-reported health behaviors (e.g., smoking, alcohol use,

exercise)

• Claims data

– ICD and CPT codes

– Paid costs

7

BMI DistributionUnderweight2%

Morbidly Obese3%

Normal40%

Overweight35%

Obese20% Underweight

Normal

Overweight

Obese

Morbidly Obese

Mean BMI = 26.7

8

Comorbidities by BMI

0%

5%

10%

15%

20%

25%

30%

35%

40%

0

2

4

6

8

10

12

14

16

Normal Overwt Obese Morbid obese

Overwt OR Obese OR Morbid obese OR

Pre

vale

nc

e

Od

ds

Rat

io

Ref: normal

adjusted for sex, age, plan site, and plan type

* p<0.05

*

*

*

*

*

** * *

9

Comorbidities by BMI

0%

3%

6%

9%

12%

15%

Cardiaccondition

Asthma Sleepapnea

Cardiaccondition

Asthma Sleepapnea

0

5

10

15

20

25

Normal Overwt Obese Morbid obese

Overwt OR Obese OR Morbid obese OR

Pre

vale

nc

e

Od

ds

Rat

io

Ref: normal

adjusted for sex, age, plan site, and plan type

* p<0.05**

*

*

*

** * *

10

Hospital Stay by BMI

0%

2%

4%

6%

8%

10%

1+ hospital stay 1+ hospital stay OR

0

0.3

0.6

0.9

1.2

1.5

Normal Overwt Obese Morbid obese

Overwt OR Obese OR Morbid obese OR

Od

ds

Rat

io

Ref: normal

adjusted for sex, age, plan site, plan type, and 6 comorbidities

* p<0.05

**

*

11

Health Care Costs by BMI

$0

$1,000

$2,000

$3,000

$4,000

TOTAL Hospital Prof Rx

Normal Overweight Obese Morbidly Obese

Sta

nd

ard

ize

d M

ean

Co

sts

b

ase

d o

n R

VU

s

12

Health Behaviors by BMI

0%

10%

20%

30%

40%

50%

Exercise (N=32,147) Smoking (N=22,444) Alcohol (N=44,473)

Normal Overweight Obese Morbidly Obese

13

Health Behaviors by BMI

0.25

0.50

0.75

1.00

1.25

1.50

Overweight Obese Morbidly Obese

Ref: normal

Adjusted for sex, age, plan site, and plan type

* p<.05

**

*

*

**

*

Od

ds

Rat

io Exercise Smoking

Alcohol

14

Strengths and Limitations

• Largest and most current database that has been used for this type of study

• HRA data

– Self-reported height, weight and health behaviors

– Survey instruments

• Claims data

– Unreported comorbidities and health care services

• Single BMI measurement, one year of claims data

15

Conclusions

• Obese more likely to have comorbidity, be hospitalized, have higher health care costs, and engage in unhealthy behaviors

• Findings will help:

– Health plans better understand how obesity is affecting

their members' health and use of health care resources as

well as the impact of obesity on their costs

– Providers, health plans, and employers identify which

conditions to focus on for disease prevention and

management programs

16

Acknowledgements• Johns Hopkins University – Jonathan Weiner, Jeanne

Clark, Hsien-Yen Chang, Tom Richards, Andrew Shore, Shari Bolen

• BCBS Association – John Newman, Greg Wozniak, Nadine Caputo, Mary Madison

• BCBS plans – BCBS of Tennessee, BCBS of Hawaii, BCBS of North Carolina, BCBS of Michigan, Independence Blue Cross, Highmark, Wellmark

• Funders – J&J Ethicon Endo-Surgery, Pfizer, GlaxoSmithKline