Prevalence and healthcare costs of obesity-related comorbidities: evidence from an electronic medical records system in the United States

Figures & data

Figure 1. *Sample selection flow chart. Conditions include malignancy, human immunodeficiency virus, cachexia, anorexia, abnormal weight gain or loss, feeding difficulties, gastrointestinal disorders, inflammatory bowel diseases, pancreatitis, and nutritional deficiencies (except for vitamin deficiency). BMI, Body mass index; FPG, Fasting plasma glucose; HbA1c, Glycosylated hemoglobin; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; GHP, Geisinger Health Plan; T2D, Type 2 diabetes.

Table 1. Annual prevalence of obesity-related comorbidities.

Comorbidities	All	Non-obesity group*	Obesity group*
	(n = 89,261)	(n = 53,321)	(n = 35,940)
Pulmonary embolism	0.50%	0.30%	0.70%
Myocardial infarction	1.40%	1.40%	1.50%
Urinary stress incontinence	1.40%	1.20%	1.80%
Ischemic stroke	2.00%	1.90%	2.00%†
Heart failure	2.30%	1.90%	2.90%
Chronic kidney disease	2.40%	2.10%	2.70%
Gallbladder diseases	2.50%	1.90%	3.30%
Pre-diabetes	2.60%	1.90%	3.60%
Angina	2.80%	2.50%	3.30%
Sleep apnea	3.90%	1.50%	7.30%
Asthma	6.60%	5.50%	8.20%
Coronary artery disease	9.20%	8.30%	10.50%
Diabetes	9.60%	5.80%	15.00%
Non-alcoholic fatty liver disease	9.70%	7.20%	13.40%
Depression	11.20%	9.90%	13.10%
Chronic obstructive pulmonary disease	11.60%	10.30%	13.50%
Chronic lower back pain	13.90%	12.60%	15.80%
Gastroesophageal reflux disease	14.20%	12.50%	16.70%
Osteoarthritis	17.50%	14.30%	22.20%
Hypertensive diseases	34.70%	27.50%	45.10%
Dyslipidemia	41.80%	37.40%	48.30%

*Differences between non-obesity and obesity groups were assessed by Chi-square test.

†The difference for ischemic stroke was not statistically significant. All other differences were statistically significant at p < 0.05.

Table 2. Individual characteristics.

	All	Non-obesity group*	Obesity group*
Number of individuals, weighted (%)	89,261 (100%)	53,321 (59.7%)	35,940 (40.3%)
Duration of study period: mean (SD), years	4.9 (3.0)	4.9 (3.0)	5.0 (2.8)
Socio-demographics at start of study period
Age: mean (SD)	46.9 (19.5)	46.3 (20.9)	47.6 (17.5)
Age group (%)
18–44	46.6%	48.6%	43.6%
45–64	38.1%	35.6%	41.9%
65–74	10.5%	10.2%	11.0%
75–84	4.3%	4.9%	3.3%
85+	0.5%	0.7%	0.2%
Male: %	47.9%	47.0%	49.3%
White: %	97.6%	97.2%	98.2%
Smoking status (%)
Never smoke	37.5%	37.8%	37.0%
Former smoke	14.2%	12.9%	16.0%
Current smoke	14.1%	14.8%	13.0%
Other/unknown	34.2%	34.4%	33.9%
Employment status (%)
Full time	43.1%	42.0%	44.7%
Not employed	10.9%	11.1%	10.5%
Other/unknown	46.1%	46.9%	44.8%
Covered by HMO insurance (%)	73.8%	73.4%	74.4%
Starting year of study period (%)
2004	57.8%	58.2%	57.2%
2005	6.7%	6.9%	6.4%
2006	8.1%	8.0%	8.4%
2007	8.0%	7.8%	8.3%
2008	7.6%	7.6%	7.5%
2009	8.5%	8.3%	8.7%
2010	3.3%	3.2%	3.5%
Characteristics during study period
BMI in the study period: mean (SD)	29.6 (7.8)	25.6 (3.5)	35.5 (6.2)
Annualized total costs: Mean (SD)	$4692 (11,155)	$4166 (10,961)	$5471 (11,336)
[Median]	[$2126]	[$1814]	[$2706]

*Differences between non-obesity and obesity groups were assessed by the student’s t-test for continuous variables and Chi-square test for categorical variables. All differences were statistically significant (p < 0.05).

BMI, Body mass index; HMO, Health maintenance organization; SD, Standard deviation.

Table 3. Estimated costs ratios and annual costs of obesity-related comorbidities.

Comorbidities	Cost ratio (95% CI)	Incremental costs*
Pulmonary embolism	2.06 (1.94–2.18)	$1665
Myocardial infarction	1.66 (1.60–1.72)	$1037
Urinary stress incontinence	1.39 (1.35–1.44)	$618
Ischemic stroke	1.99 (1.93–2.05)	$1563
Heart failure	1.64 (1.59–1.68)	$1005
Chronic kidney disease	1.46 (1.42–1.50)	$731
Gallbladder diseases	1.62 (1.58–1.67)	$984
Pre-diabetes	1.23 (1.20–1.26)	$361
Angina	1.08 (1.05–1.11)	$120
Sleep apnea	1.54 (1.51–1.57)	$850
Asthma	1.13 (1.11–1.16)	$210
Coronary artery disease	1.46 (1.44–1.49)	$732
Diabetes	1.35 (1.33–1.37)	$559
Non-alcoholic fatty liver disease	1.43 (1.41–1.45)	$684
Depression	1.60 (1.58–1.62)	$951
Chronic obstructive pulmonary disease	1.47 (1.44–1.50)	$738
Chronic lower back pain	1.46 (1.44–1.48)	$725
Gastroesophageal reflux disease	1.44 (1.42–1.45)	$687
Osteoarthritis	1.68 (1.66–1.69)	$1065
Hypertensive diseases	1.47 (1.46–1.49)	$745
Dyslipidemia	1.31 (1.30–1.32)	$486

*The incremental costs were calculated as the predicted costs of a comorbidity minus the predicted costs without any comorbidity, where the predicted costs without any comorbidity were estimated to be $1578 per subject. All differences were statistically significant at p < 0.05.

CI, Confidence interval.

Figure 2. Population level annual incremental costs of obesity-related comorbidities vs without any comorbidity. Incremental costs were calculated by multiplying prevalence and incremental costs for each obesity-related comorbidity in a population of 100,000 individuals. The bars are sorted by the incremental costs of the comorbidities. Apnea, Sleep apnea; CAD, Coronary artery disease; CKD, Chronic kidney disease; CLBP, Chronic lower back pain; COPD, Chronic obstructive pulmonary disease; GBD, Gallbladder diseases; GERD, Gastroesophageal reflux disease; HF, Heart failure; HTND, Hypertensive diseases; MI, Myocardial infarction; NAFLD, Non-alcoholic fatty liver disease; OA, Osteoarthritis; PE, Pulmonary embolism; PreD, Pre-diabetes; Stroke, Ischemic stroke; T2D, Diabetes; USI, Urinary stress incontinence.

Figure 3. Differences in annual incremental costs of obesity-related comorbidities in obesity group vs non-obesity group. Incremental costs were calculated by multiplying incremental costs for each obesity-related comorbidity to the corresponding prevalence in a population of 100,000 individuals without obesity and in a population of 100,000 individuals with obesity, respectively. The differences between the obesity population vs non-obesity population were reported. Apnea, Sleep apnea; CAD, Coronary artery disease; CKD, Chronic kidney disease; CLBP, Chronic lower back pain; COPD, Chronic obstructive pulmonary disease; GBD, Gallbladder diseases; GERD, Gastroesophageal reflux disease; HF, Heart failure; HTND, Hypertensive diseases; MI, Myocardial infarction; NAFLD, Non-alcoholic fatty liver disease; OA, Osteoarthritis; PE, Pulmonary embolism; PreD, Pre-diabetes; Stroke, Ischemic stroke; T2D, Diabetes; USI, Urinary stress incontinence.