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Relation of Body Mass Index in Young Adulthood and Middle Age to Medicare Expenditures in Older Age
Martha L. Daviglus, MD, PhD;
Kiang Liu, PhD;
Lijing L. Yan, PhD, MPH;
Amber Pirzada, MD;
Larry Manheim, PhD;
Willard Manning, PhD;
Daniel B. Garside, BS;
Renwei Wang, MD;
Alan R. Dyer, PhD;
Philip Greenland, MD;
Jeremiah Stamler, MD
JAMA. 2004;292:2743-2749.
Context Increasing prevalence of overweight/obesity and rapid aging of the US population have raised concerns of increasing health care costs, with important implications for Medicare. However, little is known about the impact of body mass index (BMI) earlier in life on Medicare expenditures (cardiovascular disease [CVD]–related, diabetes-related, and total) in older age.
Objective To examine relationships of BMI in young adulthood and middle age to subsequent health care expenditures at ages 65 years and older.
Design, Setting, and Participants Medicare data (1984-2002) were linked with baseline data from the Chicago Heart Association Detection Project in Industry (CHA) (1967-1973) for 9978 men (mean age, 46.0 years) and 7623 women (mean age, 48.4 years) (baseline overall age range, 33 to 64 years) who were free of coronary heart disease, diabetes, and major electrocardiographic abnormalities, were not underweight (BMI <18.5), and were Medicare-eligible ( 65 years) for at least 2 years during 1984-2002. Participants were classified by their baseline BMI as nonoverweight (BMI, 18.5-24.9), overweight (25.0-29.9), obese (30.0-34.9), and severely obese (35.0).
Main Outcome Measures Cardiovascular disease–related, diabetes-related, and total average annual Medicare charges, and cumulative Medicare charges from age 65 years to death or to age 83 years.
Results In multivariate analyses, average annual and cumulative Medicare charges (CVD-related, diabetes-related, and total) were significantly higher by higher baseline BMI for both men and women. Thus, with adjustment for baseline age, race, education, and smoking, total average annual charges for nonoverweight, overweight, obese, and severely obese women were, respectively, $6224, $7653, $9612, and $12 342 (P<.001 for trend); corresponding total cumulative charges were $76 866, $100 959, $125 470, and $174 752 (P<.001 for trend). For nonoverweight, overweight, obese, and severely obese men, total average annual charges were, respectively, $7205, $8390, $10 128, and $13 674 (P<.001 for trend). Corresponding total cumulative charges were $100 431, $109 098, $119 318, and $176 947 (P<.001 for trend).
Conclusion Overweight/obesity in young adulthood and middle age has long-term adverse consequences for health care costs in older age.
Author Affiliations: Department of Preventive Medicine (Drs Daviglus, Liu, Yan, Pirzada, Wang, Dyer, Greenland, and Stamler and Mr Garside), Department of Medicine, Division of Geriatrics (Drs Daviglus and Liu), Division of Cardiology (Dr Greenland), and the Institute for Health Services Research and Policy Studies (Dr Manheim), Feinberg School of Medicine, Northwestern University, Chicago, Ill; and Harris School of Public Policy Studies, the University of Chicago, Chicago (Dr Manning).
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