January 03, 2018
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Prescriptions, PCP contacts, hospital admissions rise with increasing BMI categories

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In the United States and the United Kingdom, the number of pharmaceutical prescriptions, primary care physician contacts and hospital admissions increase consistently with higher BMI categories, according to an analysis of electronic medical records data from the two countries.

“The use of new ‘big data’ technologies to perform advanced analytics on very large datasets has allowed researchers to gain insights into the behavior of real-world populations that were previously time-consuming, costly or infeasible,” Emil Nørtoft, senior health economics outcomes research manager for Novo Nordisk, and colleagues wrote. “The aim of this study is to analyze the impact of increasing BMI on health care utilization (hospitalizations, PCP contacts and prescriptions) using large population-based EMR data from both the United Kingdom and the United States. This study is one of the first that combines EMR databases from both the U.K. and the U.S., analyzing both intra- and inter-country differences in the impact of increasing BMI on health care utilization.”

Nørtoft and colleagues analyzed data from the U.K. Clinical Practice Research Datalink (n = 1,878,017) and U.S. General Electric Centricity database (GE; n = 4,414,883) of adults with a registration date before Jan. 1, 2010. Each patient was followed from an individual baseline date (latest date of BMI measurement between Jan. 1, 2008, and Jan. 1, 2010) until death or Sept. 30, 2014. Researchers analyzed differences between individuals with obesity (BMI 30 kg/m²) and without obesity on 5-year rates of PCP contacts, prescriptions and hospitalizations.

Compared with patients with BMI between 18.5 kg/m² and 24.9 kg/m², researchers observed increases in health care use with increasing BMI (P < .0001).

Patients with BMI between 30 kg/m² and 34.9 kg/m² had a higher PCP contact rate, with rate ratios of 1.27 and 1.28 for the U.K. and U.S., respectively), as well as a higher prescription rate (rate ratio = 1.61 and 1.51, respectively, for U.K. and U.S.) and higher hospitalization rate (rate ratio = 1.1 and 1.13, respectively) vs. those with BMI between 18.5 kg/m² and 24.9 kg/m².

Use increased further among patients with class II obesity. Those with BMI at least 40 kg/m² had U.K. and U.S. rate ratios of 1.56 and 1.65, respectively, for PCP contact, as well as markedly increased prescription rates (rate ratio = 2.48 and 2.14, respectively) and hospitalization rates (rate ratio = 1.27 and 1.3, respectively) vs. patients with a BMI between 18.5 kg/m² and 24.9 kg/m². Results for both groups persisted after adjusting for age and sex.

The researchers noted that the findings underscore a “real need” to increase the availability and effectiveness of current obesity treatments to drive down the current increase in health care utilization.

“This is the first time that these associations have been described in two large EMR data sets utilizing identical methods,” the researchers wrote. “The results illuminate the striking consistency in the impact of obesity on health care utilization across two very different health care systems.” – by Regina Schaffer

Disclosures: Novo Nordisk funded this study. All authors report they are employees and shareholders of Novo Nordisk.