The substantial costs to society associated with obesity – a Danish register-based study based on 2002-2018 data

Figures & data

Figure 1. Inclusion of study population.

Note: The figure presents the inclusion process for the study population. Specifically, the figure presents the remaining number of patients in the sample after each exclusion criterion was applied (left) as well as the number of patients excluded due to each of the exclusion criteria (right).

Table 1. Characteristics of people with hospital-diagnosed obesity.

	Study population
Total population	90,020 (100%)
Sex, n (%)
Man	21,253 (24%)
Woman	68,767 (76%)
Age, mean (SD)	51.0 (15.2)
Age, n (%)
18–39 years	21,997 (24%)
40–65 years	50,267 (56%)
>65 years	17,756 (20%)
Obesity class at inclusion, n (%)
Obesity class I (30–34.9 kg/m^2)	42,373 (49%)
Obesity class II (35–39.9 kg/m^2)	28,014 (32%)
Obesity class III (≥40 kg/m^2)	16,594 (19%)
Region of residence, n (%)
North Denmark Region	7,367 (8%)
Central Denmark Region	20,177 (22%)
Region of Southern Denmark	25,231 (28%)
Capital Region of Denmark	21,564 (24%)
Region Zealand	15,681 (17%)
Educational level, n (%)
Primary or no education	32,137 (36%)
Secondary	38,078 (42%)
Short-cycle tertiary	3,009 (3%)
Bachelor’s or equivalent	12,552 (14%)
Master’s or higher	2,310 (3%)
Education unknown	1,934 (2%)

The table presents sociodemographic characteristics for people with hospital-diagnosed obesity who were included in the study population. ‘Primary’ education comprises 10 years of compulsory education. ‘Secondary’ education is divided into general secondary programs (two to three years of education) and vocational secondary education and training programs (four years of education). ‘Short-cycle tertiary’ comprises two to two and a half years of education. ‘Bachelor’s or equivalent’ covers three to three and a half years of education. ‘Master’s or higher’ includes master’s (two-year) degree and PhD (three-year) programs.

Figure 2. (a) Breakdown of total healthcare costs; (b) Breakdown of cost attributable to obesity.

Note: The figure presents (A) the total yearly healthcare costs and (B) the yearly healthcare costs attributable to obesity, by cost category, for people with obesity.

Table 2. Average annual direct healthcare costs per person from 2002 to 2018, EUR.

	Cases (N = 90,020) EUR (95% CI)	Controls (n = 448,570) EUR (95% CI)	Difference, EUR (%)	P-value
Cost of inpatient hospitalization	2,758 (2,733–2,782)	1,110 (1,103–1,117)	1,647 (148%)	<.0001
Somatic inpatient hospitalizations	2,372 (2,355–2,388)	942 (937–947)	1,430 (152%)	<.0001
Psychiatric inpatient hospitalizations	386 (368–403)	168 (163–173)	218 (130%)	<.0001
Cost of outpatient visits	1,783 (1,774–1,792)	947 (944–950)	836 (88%)	<.0001
Somatic outpatient visits	1,638 (1,629–1,646)	872 (869–875)	766 (88%)	<.0001
Psychiatric outpatient visits	145 (143–148)	75 (74–76)	70 (94%)	<.0001
Cost of primary care visits	566 (565–568)	383 (383–384)	183 (48%)	<.0001
Cost of home care	413 (404–422)	184 (181–187)	229 (124%)	<.0001
Cost of prescription medicine	414 (412–416)	164 (163–164)	250 (153%)	<.0001
Anti-obesity medication	4 (3–4)	0	4	<.0001
Psychiatric	45 (44–45)	21 (21–21)	23 (112%)	<.0001
Total healthcare costs	5,934 (5,904–5,964)	2,788 (2,779–2,797)	3,146 (113%)	<.0001

The table presents average yearly healthcare costs by cost category for people with hospital-diagnosed obesity (cases) and for their matched controls, along with the differences in healthcare costs. P-value refers to a t-test of the difference.

Abbreviations: NA, not applicable.

Table 3. Average annual number of contacts with the healthcare sector per person.

	Cases (N = 90,020) mean (95% CI)	Controls(n = 448,570) mean (95% CI)	Difference	P-value
Inpatient hospitalizations	0.146 (0.145–0.146)	0.072 (0.072–0.072)	0.074 (103%)	<.0001
Somatic inpatient hospitalizations	0.14 (0.139–0.14)	0.069 (0.069–0.069)	0.071 (102%)	<.0001
Psychiatric inpatient hospitalizations	0.006 (0.006–0.006)	0.003 (0.003–0.003)	0.003 (104%)	<.0001
Outpatient visits	0.577 (0.575–0.58)	0.284 (0.283–0.285)	0.293 (103%)	<.0001
Somatic outpatient visits	0.516 (0.514–0.518)	0.253 (0.252–0.253)	0.263 (104%)	<.0001
Psychiatric outpatient visits	0.061 (0.06–0.062)	0.031 (0.031–0.032)	0.03 (96%)	<.0001

The table presents average yearly healthcare utilization by category of healthcare service for people with hospital-diagnosed obesity (cases) and for their matched controls, along with the differences in healthcare utilization. P-value refers to a t-test of the difference.

Abbreviations: NA, not applicable.

Table 4. Average annual earnings and receipt of transfer payments per person, EUR.

	Cases (N = 90,020) EUR (95% CI)	Controls (n = 448,570) EUR (95% CI)	Difference, EUR (%)	P-value
Gross earnings	21,392 (21,326–21,458)	26,869 (26,834–26,904)	−7,477 (−20%)	<.0001
Transfer payments	12,635 (12,613–12,658)	9,691 (9,682–9,701)	2,944 (30%)	<.0001

The table presents average yearly earnings and receipts of transfer payments for people with hospital-diagnosed obesity (cases) and for their matched controls, along with the differences in average yearly earnings and receipts of transfer payments. P-value refers to a t-test of the difference.

Table 5. Total annual healthcare costs and diagnosis-specific healthcare costs for people with selected comorbidities, EUR.

No comorbidities

Chronic kidney disease

Heart failure

Unstable angina

Myocardial infarction

Atrial fibrillation

Dyslipidemia

Diabetes type II

Hypertension

Asthma

Obstructive sleep apnea

Hip and knee osteoarthritis

Total healthcare costs for people with each comorbidity, including cost of obesity

Total costs

3,805

16,852(16,489–17,215)

13,376(13,149–13,602)

11,902(11,531–12,273)

10,346(10,111–10,581)

10,104(9,961–10,246)

9,455(9,118–9,792)

8,070(8,007–8,134)

7,890(7,792–7,988)

7,793(7,722–7,865)

7,567(7,464–7,670)

7,293(7,226–7,361)

Healthcare costs that can be directly associated with the comorbidity

Total costs

-

2,419(2,267–2,570)

942(897–987)

500(460–541)

908(867–950)

582(564–601)

252(233–271)

334(330–338)

125(122–129)

167(164–171)

249(242–255)

790(776–803)

Inpatient hospitalizations

-

449(411–488)

765(722–809)

464(424–503)

855(814–895)

426(409–444)

212(194–230)

54(51–56)

52(50–55)

19(17–21)

97(91–103)

671(659–684)

Outpatient visits

-

1,969(1,835–2,103)

176(169–184)

36(30–42)

54(48–59)

146(142–150)

40(36–43)

188(185–191)

67(65–68)

43(40–45)

152(149–154)

118(117–120)

Prescription medicines

-

-

-

-

-

10(10–11)

-

93(92–93)

6(6–6)

106(104–107)

-

-

N

32,280

2,082

3,545

1,129

2,788

6,302

1,863

25,445

8,514

23,532

10,369

15,973

The table presents the total healthcare costs for patients with a certain comorbidity in addition to a BMI>30, as well as the healthcare costs specifically related to that comorbidity. Diagnosis-related healthcare costs are stratified according to inpatient hospitalizations, outpatient visits and prescription medicines.

Figure 3. Total annual healthcare costs and diagnosis-specific healthcare costs by number of registered comorbidities, EUR.

Note: The figure presents the total healthcare costs for patients with a certain number of registered comorbidities in addition to a BMI>30, as well as the healthcare costs specifically related to these comorbidities. Diagnosis-related healthcare costs are stratified according to inpatient hospitalizations and outpatient visits.

Figure 4. (a) Average annual healthcare costs per person in the subgroups; (b) Average annual earnings and transfer payments per person in the subgroups.

Note: The figure presents average yearly healthcare costs and yearly earnings and transfer payments by subgroup for people with hospital-diagnosed obesity (cases) and for their matched controls.

Data availability statement

Data are available as presented in the manuscript. According to Danish legislation, our approvals to use Danish data for the current study do not permit us to share patient data or make it available to other parties. Researchers must apply for data access directly to Statistics Denmark through the Research Service.