Abdominal obesity and healthcare costs related to hypertension and diabetes in older adults
Palabras clave:
Aging, Health care costs, Obesity abdominal, Public healthResumen
Objective
To analyze the association between excess abdominal fat and healthcare costs related to hypertension and diabetes Mellitus in older adults.
Methods
These cross-sectional analyses are part of the Health, Wellbeing and Aging Study conducted in São Paulo, Brazil, with 806 older adults with self-reported hypertension and diabetes Mellitus. The study included the annual costs with medicines, hospital admissions, and outpatient services for hypertension and diabetes Mellitus control. Excess abdominal fat was diagnosed based on waist circumference. Level of physical activity, age, and gender were considered covariates. The sample was divided into two groups according to waist circumference. Multiple logistic regression analyzed the associations between annual costs and waist
circumference.
Results
The cost of services and hospitalizations (R$551.05; 95%CI=418.27–683.83) and total costs (R$817.77; 95%CI=669.21–966.33) were higher in the excess abdominal fat group. Older adults with high waistcircumference had higher odds of increasing annual costs due to medicines (OR=2.6; 95%CI=1.13–3.77), regardless of gender, age, and level of physical activity.
Conclusion
Healthcare costs for treating hypertension and diabetes Mellitus in older adults are higher in the presence of excess abdominal fat.
Citas
Department of Economic and Social Affairs. World Population Ageing 2013. New York: United Nations; 2013.
Nascimento CDM, Vaz J, Mambrini DM, Oliveira CM, Giacomin KC, Peixoto SV. Diabetes, hypertension and mobility among Brazilian older adults: Findings from the Brazilian National Household Sample Survey (1998, 2003 and 2008). BMC Public Health. 2015;15:1-7. https://doi.org/10.1186/s12889-015-1956-2
Lebrão ML. O envelhecimento no Brasil: aspectos da transição demográfica e epidemiológica. Saúde Coletiva. 2007 [acesso 2015 abr 1];4:135-40. Disponivel em: http://www.prefeitura.sp.gov.br/cidade/secretarias/upload/saude/arquivos/pessoaidosa/EnvelhecimentoBrasil-TransicaoMLLebrao-SaudeColetiva2007.pdf
Redón J, Cea-Calvo L, Moreno B, Monereo S, GilGuillén V, Lozano J V, et al. Independent impact of obesity and fat distribution in hypertension prevalence and control in the elderly. J Hypertens. 2008;26(9):1757-64.
Chrysohoou C. Association between prehypertension status and inflammatory markers related to atherosclerotic disease: The ATTICA Study. Am J Hypertens. 2004;17(7):56-73. https://doi.org/10.1016/j.amjhyper.2004.03.675
Peeters AC, Netea MG, Janssen MC, Kullberg BJ, Van der Meer JW, Thien T. Pro-inflammatory cytokines in patients with essential hypertension. Eur J Clin Invest. 2001;31(1):31-6.
Scheen AJ. Diabetes Mellitus in the elderly: Insulin resistance and/or impaired insulin secretion? Diabetes Metab. 2005;31(2):5S27-34.
Hodgson TA, Cai L. Medical care expenditures for hypertension, its complications, and its comorbidities. Med Care. 2001;39(6):599-615.
Jackson CL, Yeh H-C, Szklo M, Hu FB, Wang N-Y, Dray-Spira R, et al. Body-Mass Index and all-cause mortality in US adults with and without diabetes. J Gen Intern Med. 2013;29(1):25-33.
Suemoto CK, Lebrao ML, Duarte YA, Danaei G. Effects of body mass index, abdominal obesity, and type 2 diabetes on mortality in community-dwelling elderly in Sao Paulo, Brazil: Analysis of prospective data from the SABE Study. J Gerontol Ser A Biol Sci Med Sci. 2015;70(4):503-10. https://doi.org/10.1093/gerona/glu165
Moreira GC, Cipullo JP, Martin JFV, Ciorlia LA, Godoy MRP, Cesarino CB, et al. Evaluation of the awareness, control and cost-effectiveness of hypertension treatment in a Brazilian city: Populational study. J Hypertens. 2009;27(9):1900-7.
Dib MW, Riera R, Ferraz MB. Estimated annual cost of arterial hypertension treatment in Brazil. Rev Panam Salud Pública. 2010;27(2):125-31.
Lebrão ML, Duarte YAO. SABE - Saúde, Bem-estar e Envelhecimento – o projeto SABE no município de São Paulo: uma abordagem inicial. Brasília: Organização Pan-Americana de Saúde; 2003.
Han TS, van Leer EM, Seidell JC, Lean MEJ. Waist circumference action levels in the identification of cardiovascular risk factors: Prevalence study in a random sample. Br Med J. 1995; 311(7017):1401-5.
Lean MEJ, Han TS. Waist circumference as a measure for indicating need for weight management. Br Med J. 1995; 311(6998):158-61
World Health Organization. Global recommendations on physical activity for health. Geneva: WHO; 2010 [cited 2016 Mar 1]. Available from: http://www.who.int/dietphysicalactivity/factsheet_recommendation/en/
Institut Ferran de Reumatologia. Guidelines for data processing and analysis of the International Physical Activity Questionnaire (IPAQ): Short and long forms. Barcelona: Institut Ferran de Reumatologia; 2005.
Raebel MA, Malone DC, Conner DA, Xu S, Porter JA, Lanty FA. Health services use and health care costs of obese and nonobese individuals. Arch Intern Med. 2004;164(19):2135-40. 19. Wang F, McDonald T, Reffitt B, Edington DW. BMI, physical activity, and health care utilization/costs among Medicare retirees. Obes Res. 2005;13(8):1450-7.
Bahia L, Coutinho ES, Barufaldi L, de Azevedo Abreu G, Malhão T, Ribeiro de Souza C, et al. The costs of overweight and obesity-related diseases in the Brazilian public health system: Cross-sectional study. BMC Public Health. 2012;12(1):440. Available from: http://www.biomedcentral.com/1471-2458/12/440
Rtveladze K, Marsh T, Webber L, Kilpi F, Levy D, Conde W, et al. Health and economic burden of obesity in Brazil. PLoS One. 2013;8(7):e68785.
Withrow D, Alter DA. The economic burden of obesity worldwide: A systematic review of the direct costs of obesity. Obes Rev. 2011;12(2):131-41.
Yu AP, Wu EQ, Birnbaum HG, Emani S, Fay M, Pohl G, et al. Short-term economic impact of body weight change among patients with type 2 diabetes treated with antidiabetic agents: Analysis using claims, laboratory, and medical record data. Curr Med Res Opin. 2007;23(9):2157-69. Available from: https://doi.org/10.1185/0300799007X219544.
Lee CMY, Huxley RR, Wildman RP, Woodward M. Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: A meta-analysis. J Clin Epidemiol. 2008;61(7):646-53.
Marinho MGDS, Cesse EÂP, Bezerra AFB, Sousa IMC, Fontbonne A, Carvalho EF. Analysis of health care costs of patients with diabetes Mellitus and hypertension in a public health reference unit in Recife – Brazil. Arq Bras Endocrinol Metabol. 2011;55(6):406-11.
Lessa Í. Impacto social da não-adesão ao tratamento da hipertensão arterial. Arq Bras Cardiol. 2006;13(1):39-46.
Xavier HT, Izar MC, Faria Neto JR, Assad MH, Rocha VZ, Sposito AC, et al. V Brazilian Guidelines on Dyslipidemias and Prevention of Atherosclerosis. Arq Bras Cardiol. 2013;101(4Suppl.1):1-20. https://doi.org/10.5935/abc.2013S010
Rocha FL, de Menezes TN, Pimenteira de Melo RL, Figueroa Pedraza D. Correlação entre indicadores de obesidade abdominal e lipídeos séricos em idosos. Rev Assoc Med Bras. 2013;59(1):48-55. https://doi.org/10.1590/S0104-42302013000100011
Duh MS, Fulcher NM, White LA, Jayawant SS, Ramamurthy P, Moyneur E, et al. Costs associated with cardiovascular events in patients with hypertension in US managed care settings. J Am Soc Hypertens. 2009;3(6):403-15. https://doi.org/10.1016/j.jash.2009.09.001
Wong YW, Thomas L, Sun J-L, McMurray JJ V, Krum H, Hernandez AF, et al. Predictors of incident heart failure hospitalizations among patients with impaired glucose tolerance: Insight from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research study. Circ Heart Fail. 2013;6(2):203-10. https://doi.org/10.1161/CIRCHEARTFAILURE.112.000086
Oliveira JS, de Lira PIC, Veras ICL, Maia SR, de Lemos MCC, de Andrade SLLS, et al. Estado nutricional e insegurança alimentar de adolescentes e adultos em duas localidades de baixo indice de desenvolvimento humano. Rev Nutr. 2009;22(4):453-65. https://doi.org/10.1590/S1415-52732009000400002
Gouveia LA, Marucci MFN, Lebrão ML, Duarte YAO. Association between waist circumference (WC) values and hypertension, heart disease (HD) and diabetes, reported by the elderly – SABE survey: Health, wellness and aging, 2000 and 2006. Arch Gerontol Geriatr. 2014;59(1):62-8. https://doi.org/10.1016/j.archger.2014.02.005
Silva VS, Souza I, Silva DAS, Barbosa AR, Fonseca M J. Trends and association of BMI and influence of between variables sociodemographic and of living conditions in the elderly in Brazil: 2002/03-2008/09. Ciên Saúde Coletiva. 2016;30(7):1-9.
Sociedade Brasileira de Cardiologia. II Diretrizes em Cardiogeriatria. Arq Bras Cardiol. 2010;95(3Supl.2):1-112.
Gusi N, Reyes MC, Gonzalez-Guerrero JL, Herrera E, Garcia JM. Cost-utility of a walking programme for moderately depressed, obese, or overweight elderly women in primary care: A randomised controlled trial. BMC Public Health. 2008;8(1):231. https://doi.org/10.1186/1471-2458-8-231
Bueno DR, Rosa CSC, Codogno JS, Freitas Junior IF, Monteiro HL. Nível de atividade física, comorbidades e idade de pacientes hipertensos. Mot Rev Educ Física. 2013;19(3):16-24. https://doi.org/10.1590/S1980-65742013000700004
Salvador EP, Florindo AA, Reis RS, Costa EF. Percepção do ambiente e prática de atividade física no lazer entre idosos. Rev Saúde Publica. 2009;43(6):972-80.
Marquez DX, Hoyem R, Fogg L, Bustamante EE, Staffileno B, Wilbur J. Physical activity of urban community-dwelling older Latino adults. J Phys Act Health. 2011;8(Suppl.2):S161-70.
Freitas AMDP, Philippi ST, Ribeiro SML. Listas de alimentos relacionadas ao consumo alimentar de um grupo de idosos: análises e perspectivas. Rev Bras Epidemiol. 2011;14(1):161-77.
Previato HDRA, Barros FSS, Mello JDBM, Silva FCS, Nimer M. Perfil clínico-nutricional e consumo alimentar de idosos do Programa Terceira Idade, Ouro Preto-Mg. Demetra Aliment Nutr Saúde. 2015;10(2):375-88. https://doi.org/10.12957/demetra.2015.15014
Ministério da Saúde (Brasil). Secretaria de Atenção à saúde. Guia alimentar aara a população brasileira. Brasília: Ministério da Saúde; 2014.
Silveira RE, Santos ÁDS, Sousa MC, Monteiro TSA. Gastos relacionados a hospitalizações de idosos no Brasil: perspectivas de uma década. Einstein (São Paulo). 2013;11(34):514-20. https://doi.org/10.1590/S1679-45082013000400019
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2023 Denise Rodrigues BUENO, Maria de Fátima Nunes MARUCCI, Luiza Antoniazzi GOUVEIA, Yeda Aparecida de Oliveira DUARTE, Maria Lúcia LEBRÃO
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
