Health care expenditures among working-age adults with physical disabilities: Variations by disability spans

BackgroundData on health care costs for working-age adults with physical disabilities are sparse and the dynamic nature of disability is not captured.ObjectivesTo assess the effect of 3 types of disability status (persistent disability, temporary disability, and no disability) on health care expenditures, out-of-pocket (OOP) spending, and financial burden.MethodsData from Medical Expenditure Panel Survey panel 12 (2007–2008) were used. Respondents were classified into 3 groups. Medians of average annual expenditures, OOP expenditures, and financial ratios were weighted. The package R was used for quantile regression analyses.ResultsFifteen percent of the working-age population reported persistent disabilities and 7% had temporary disabilities. The persistent disability group had the greatest unadjusted annual medians for total expenditures ($4234), OOP expenses ($591), and financial burden ratios (1.59), followed by the temporary disability group ($1612, $388, 0.71 respectively). The persistent disability group paid approximately 15% of total health care expenditures out-of-pocket, while the temporary disability group and the no disability group each paid 22% out-of-pocket. After adjusting for other factors, quantile regression shows that the persistent disability group had significantly higher total expenditures, OOP expenses, and financial burden ratios (coefficients 1664, 156, 0.58 respectively) relative to the no disability group at the 50th percentile. Results for the temporary disability group show a similar trend except for OOP expenses.ConclusionsPeople who have disabling conditions for a longer period have better financial protection against OOP health care expenses but face greater financial burdens because of their higher out-of-pocket expenditures and their socioeconomic disadvantages.     

Food insecurity is associated with obesity among US adults in 12 states

A redesigned food insecurity question that measured food stress was included in the 2009 Behavioral Risk Factor Surveillance System in the Social Context optional module. The objective of our study was to examine the association between food stress and obesity using this question as a surrogate for food insecurity. Our analytic sample included 66,553 adults from 12 states. Food insecurity was determined by response (always/usually/sometimes) to the question, “How often in the past 12 months would you say you were worried or stressed about having enough money to buy nutritious meals?” T tests were used to compare prevalence differences between groups, and logistic regression was used to examine the association between food insecurity and obesity. Among the 12 states, the prevalence of obesity was 27.1% overall, 25.2% among food secure adults, and 35.1% among food insecure adults. Food insecure adults had 32% increased odds of being obese compared to food secure adults. Compared with food secure adults, food insecure adults had significantly higher prevalence of obesity in the following population subgroups: adults ages ≥30 years, women, non-Hispanic whites, non-Hispanic blacks, adults with some college education or a college degree, a household income of <$25,000 or $50,000 to $74,999, and adults with none or two children in their households. One in three food insecure adults were obese. Food insecurity was associated with obesity in the overall population and most population subgroups. These findings are consistent with previous research and highlight the importance of increasing access to affordable healthy foods for all adults.     

Disparities in overweight and obesity among US college students

OBJECTIVES: To examine social disparities and behavioral correlates of overweight and obesity over time among college students. METHODS: Multilevel analyses of BMI, physical activity, and television viewing from 2 representative surveys of US college students (n=24,613). RESULTS: Overweight and obesity increased over time and were higher among males, African Americans, and students of lower socioeconomic position and lower among Asians. Television viewing and in activity were associated with obesity, and disparities in these behaviors partially accounted for excess weight among African Americans. CONCLUSIONS: Social disparities in overweight and obesity exist among college students. Promoting physical activity and reducing television viewing may counteract increasing trends.     

Health care costs in old age are related to overweight and obesity earlier in life

Obesity is responsible for at least 90 billion dollars in direct U.S. health care costs annually. A high proportion of people who were overweight or obese at younger ages survives past age sixty-five to experience adverse consequences. The determinants of obesity are complex and multifactorial, with genetic, biological, behavioral, social, and environmental contributors. The effects of adverse weight in older age have negative implications for healthy aging and lead to greater societal expenditures. Given the high costs and ineffectiveness of existing programs to treat obesity, perhaps the only solution to the obesity epidemic is primary prevention of weight gain beginning in youth.     

中国成年人超重肥胖影响因素meta分析

目的 定量评价近年来中国成年人超重肥胖的影响因素。方法 在PubMed、CNKI、万方数据库中进行文献检索,收集2010-2014年3月公开发表的关于中国成年人超重肥胖影响因素的调查研究。采用RevMan5.1和Stata11软件进行meta分析,用固定效应模型或随机效应模型进行数据合并,计算OR值和95%CI。用Begg秩相关和漏斗图来判定发表偏倚。结果 共纳入的19篇文献,包括95 798名调查者,影响因素合并的OR及95%CI分别为:高脂饮食1.37(1.17~1.59)、饮酒1.12(1.03~1.22)、年龄1.03(1.01~1.05)、吸烟0.72(0.67~0.77)、运动0.79(0.63~0.98),且均具有统计学意义。结论 高脂饮食、饮酒和年龄是中国成年人超重肥胖的危险因素,运动、吸烟是其保护性因素。     

天津市社区成年人超重及肥胖现况分析

目的 了解天津市成年人超重和肥胖流行现状,为制定相应干预措施提供科学依据。方法 按分层整群随机抽样方法,抽取天津市内24个社区≥18岁常住居民进行问卷调查及身体检查。结果 调查对象超重率为34.3%(8 072/23 533),肥胖率为10.7%(2 518/23 533),按2000年全国人口标化后,标化超重率为30.2%,标化肥胖率为9.2%。高于2002年中国居民营养与健康状况调查结果;中年组超重率最高,为41.7%(3 099/7 431),老年组肥胖率最高,为13.9%(932/6 703),青年组超重率和肥胖率均为最低;中、老年组超重和肥胖合计>50%;调查对象腹型肥胖率最高,老年组腹型肥胖率男性为22.1%,女性为25.5%。结论 天津市社区居民超重和肥胖患病率较高,男性中老年人群应为防治重点。     

Factors associated with overweight and obesity among Kuwaiti kindergarten female teachers

Levels of overweight and obesity among Kuwaiti women are high, and the objective of this study was to explore factors that may be responsible. A sample of 461 Kuwaiti kindergarten female teachers was studied; weight and height were measured, and the classification of overweight or obese taken as having a Body Mass Index of 25-30 or >30, respectively. This revealed that 41.2 and 19.7% of the teachers were overweight or obese, respectively. Factors found to be significantly associated with overweight and obesity among the teachers included age, marital status, parents living at home, subjects' parental obesity, number of obese relatives, exercise, last dental check-up and dental status.     

Social class, family, and life-style factors associated with overweight and obesity among adults in Peruvian cities

BACKGROUND: Overweight and obesity have reached epidemic proportions in Latin America. OBJECTIVE: The purpose of this study was to explore social and behavioral factors associated with obesity in Peruvian cities. DESIGN: Between 1998 and 2000 health examination surveys were conducted among adults in 1176 families identified in six cities. Stratified by social class, multistaged random sampling was used. Using body mass index (weight (kg)/height (m)(2)), men and women were classified into normal weight (BMI <25), overweight (BMI 25-29), or obese (BMI > or =30); abdominal circumference (> or =94 cm in men and > or =84 cm in women) further identified morbidity risk. Several demographic, social, and behavioral variables were collected following standardized procedures. RESULTS: Adjusting for age, 37% of women were categorized as normal weight, 40% overweight, and 23% obese; corresponding figures for men were 40, 44, and 16%. More developed cities, e.g., Lima, Arequipa, and Ica, had the largest prevalence of overweight and obesity for both men and women. Adjusted logistic models showed that BMI > or =25 was positively correlated with age; whereas, education was negatively associated, only among women. Other significant associated factors of overweight included city of residence, television viewing > or =4 h daily in women, and underestimation of body weight status. CONCLUSIONS: The study showed elevated rates of overweight across the income level spectrum. Factors such as urban development stage, income, education, and gender posed differential relationships with the risk of overweight and must be considered in designing future public health interventions. Underestimation of body weight status and sedentary behavior may also constitute specific areas of intervention.     

Income and race/ethnicity are associated with adherence to food-based dietary guidance among US adults and children

BackgroundIncome and race/ethnicity are associated with differences in dietary intakes that may contribute to health disparities among members of the US population.ObjectiveTo examine alignment of intakes of food groups and energy from solid fats, added sugars, and alcohol with the 2005 Dietary Guidelines for Americans and MyPyramid, by family income and race/ethnicity.DesignData from the National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey, for 2001-2004.Participants/settingPersons aged ≥2 years for whom reliable dietary intake data were available (n=16,338) were categorized by income (lowest, middle, and highest) and race/ethnicity (non-Hispanic white, non-Hispanic black, and Mexican American).Statistical analyses performedThe National Cancer Institute method was used to estimate the proportions of adults and children in each income and race/ethnic group whose usual intakes met the recommendations.ResultsHigher income was associated with greater adherence to recommendations for most food groups; the proportions meeting minimum recommendations among adults in the highest income group were double that observed for the lowest income group for total vegetables, milk, and oils. Fewer differences by income were apparent among children. Among the race/ethnic groups, the proportions meeting recommendations were generally lowest among non-Hispanic blacks. Marked differences were observed for milk—15% of non-Hispanic black children met the minimum recommendations compared with 42% of non-Hispanic white children and 35% of Mexican-American children; a similar pattern was evident for adults. One in five Mexican-American adults met the dry beans and peas recommendations compared with approximately 2% of non-Hispanic whites and non-Hispanic blacks. Most adults and children consumed excess energy from solid fats and added sugars irrespective of income and race/ethnicity.ConclusionsThe diets of some subpopulations, particularly individuals in lower-income households and non-Hispanic blacks, are especially poor in relation to dietary recommendations, supporting the need for comprehensive strategies to enable healthier dietary intake patterns.     

Environmental and policy factors associated with overweight among adults in Missouri

PURPOSE: To measure the association between environmental and policy factors (i.e., community perceptions, community infrastructure, and worksite infrastructure) and being overweight. DESIGN: Cross-sectional data from the Missouri Cardiovascular Disease Survey, a one-time random-digit-dialed telephone interview of noninstitutionalized adults. SETTING: Missouri, 1999 to 2000. SUBJECTS: The response rate was 69.6%. A total of 2821 adults completed the interview. The sample was weighted to represent the population of Missouri: 52% female, 71% white, and 59% overweight. MEASURES: The survey comprised 92 closed-ended multiple-choice items. Overweight was defined as a body mass index greater than or equal to 25 kg/m2 on the basis of self-reported height and weight. RESULTS: After adjustment for demographic and behavioral factors, environmental variables associated with being overweight included negative (i.e., unsafe and unpleasant) community perceptions (adjusted odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.1, 2.3) and the absence of outdoor exercise facilities (OR = 1.2; CI = 1.0, 1.5). Worksite policy variables were not related to the outcome; however, negative community perceptions (OR = 2.8; CI = 1.5, 5.2) and the absence of sidewalks and shoulders (OR = 1.7; CI = 1.3, 2.4) were associated with overweight among employed persons. CONCLUSIONS: An ecological perspective, focusing on the physical and social environment, was adopted to address the subject of overweight and obesity. Results of this study show that negative perceptions of the physical environment and the absence of enabling infrastructure are modestly associated with overweight, in comparison with other known risk factors. Environmental and policy interventions that promote healthier lifestyles by encouraging physical activity and healthy eating may have an effect on reducing the prevalence of overweight and obesity.     

A Preliminary analysis of medical expenditures among active and sedentary US adults with mental disorders

OBJECTIVE: To determine whether leisure-time physical activity is associated with lower direct annual medical expenditures among a sample of adults with mental disorders. METHODS: Using the 1995 National Health Interview Survey and 1996 Medical Expenditure Panel Survey, differences between medical expenditures for sedentary and active persons were analyzed using t-tests. RESULTS: The per capita annual direct medical expenditure was US 2785 dollars higher for sedentary than for active persons (P<0.05). The total expenditure associated with sedentary behavior was US 31.7 billion dollars (US 19.1 billion dollars in men; US 12.6 billion dollars in women). CONCLUSIONS: Physical activity is associated with a reduced economic burden among people with mental disorders.     

Self-reported overweight and obesity are not associated with concern about enough food among adults in New York and Louisiana

BACKGROUND: A causal relationship between hunger and obesity has been postulated. Two cross-sectional studies have found evidence to suggest an association between obesity and food insecurity among adult women, and a third study suggests an association between underweight and food insecurity among men. The purpose of this study was to investigate the association between concern about enough food and obesity in an adult population at the state level. METHODS: A cross-sectional analysis was conducted using 1999 data from the Behavioral Risk Factor Surveillance System (BRFSS), Social Context Module (n = 3,945). RESULTS: An 8.0% prevalence of concern about enough food was found in Louisiana, and an 11.8% prevalence was found in New York, and was positively associated with morbid obesity, RR = 2.20 (95% CI = 1.24, 3.90) and RR = 2.23 (95% CI = 1.30, 3.84), respectively. However, this association became nonsignificant after controlling for education, income, race/ethnicity, marital status, and general health. CONCLUSION: A very strong apparent relationship between concern about enough food and obesity could be entirely accounted for by the influences of socioeconomic variables. This emphasizes the need for longitudinal research studies using precise measures of weight, height, and food security.     

Multiple health behaviors and serum hepatic enzymes among US adults with obesity

IntroductionThis study was to examine the cumulative number and clustering patterns of low-risk health behaviors (i.e., not currently smoking, not excessive drinking, and physically active) associated with elevation of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) among adults with obesity in the United States.MethodsWe estimated the age-adjusted prevalence of elevated ALT, AST, and GGT from 4547 adults with obesity aged ≥ 20 years who participated in the 2005–2008 National Health and Nutrition Examination Survey. The associations between the cumulative number or clustering patterns of low-risk health behaviors and measures of serum ALT, AST, and GGT were assessed using multivariate regression models.ResultsAdult men who reported having three low-risk health behaviors were 62%, 39%, and 48% less likely to have elevated serum ALT, AST, and GGT, respectively; adult women were 56% and 73% less likely to have elevated serum AST and GGT, respectively, when compared to their respective counterparts who reported having none of the low-risk health behaviors.ConclusionsThe findings of this study indicate that, among adults with obesity, having multiple low-risk health behaviors is associated with decreased likelihoods of elevated hepatic enzymes, including ALT in men, AST and GGT in both men and women.     

Education and obesity at age 40 among American adults

Although many have studied the association between educational attainment and obesity, studies to date have not fully examined prior common causes and possible interactions by race/ethnicity or gender. It is also not clear if the relationship between actual educational attainment and obesity is independent of the role of aspired educational attainment or expected educational attainment. The authors use generalized linear log link models to examine the association between educational attainment at age 25 and obesity (BMI ≥ 30) at age 40 in the USA's National Longitudinal Survey of Youth 1979 cohort, adjusting for demographics, confounders, and mediators. Race/ethnicity but not gender interacted with educational attainment. In a complete case analysis, after adjusting for socioeconomic covariates from childhood, adolescence, and adulthood, among whites only, college graduates were less likely than high school graduates to be obese (RR = 0.69, 95%CI: 0.57, 0.83). The risk ratio remained similar in two sensitivity analyses when the authors adjusted for educational aspirations and educational expectations and analyzed a multiply imputed dataset to address missingness. This more nuanced understanding of the role of education after controlling for a thorough set of confounders and mediators helps advance the study of social determinants of health and risk factors for obesity.     

辽宁省成人超重与肥胖流行病学调查

目的调查辽宁省城乡20周岁以上居民超重与肥胖的流行状况,为有针对性地开展肥胖防治提供科学依据.方法对4个城市及农村和两个大型国有企业部分职工进行自填式问卷调查,采用WHO诊断标准,以1990年全国人口普查年龄别人口比例计算超重和肥胖调整现患率.结果共调查37 070人,超重及肥胖调整现患率男性为24.77%和2.87%,明显高于全国平均水平;女性为17.24%和1.96%,明显低于全国平均水平.男女超重现患率在各年龄组间有显著性差异,均随年龄增加而上升.男性商业与交通运输业人员肥胖现患率最高,待业人员及农民最低;女性中家庭妇女和农民超重现患率明显高于其他职业.女性超重和肥胖现患率均随着文化程度的增高而明显降低,而男性则呈现相反趋势.本次调查所发现的年轻及知识女性超重与肥胖现患率较低是否与调查方式有关值得进一步研究.结论辽宁省超重及肥胖调整现患率男性明显高于全国平均水平,存在显著的性别、年龄、职业和文化间差别.     

Eating away from home is associated with overweight and obesity among Ugandan adults: the 2014 Uganda non-communicable disease risk factor survey

BACKGROUND/OBJECTIVESWe investigated the associations between eating away from home (EAFH) and overweight and obesity among Ugandan adults using the 2014 Uganda non-communicable disease risk factor survey.SUBJECTS/METHODSIn total, 3,025 participants aged 18–69 years were included in the analysis. The frequency of EAFH was assessed by asking participants the number of meals eaten per week that were not prepared at a home. EAFH frequency was categorized as; less than once/week, 1-2 times/week, or ≥ 3 times/week. Logistic regression was used to evaluate the associations between overweight, obesity, and EAFH. We also tested whether sex and age modified these associations.RESULTSParticipants that ate away from home ≥ 3 times/week were 2.13 times more likely to be obese than those that ate away from home less than once/week (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.28–3.54). However, when the analysis was stratified by sex, women that ate away from home ≥ 3 times/week were 42% less likely to be overweight than those that ate away from home less than once/week (OR, 0.58; 95% CI, 0.36–0.94). Men that ate away from home ≥ 3 times a week were 3.89 times and 2.23 times more likely to be obese and overweight, respectively, than those that ate away from home less than once/week (obesity: OR, 3.89; 95% CI, 1.50–10.09; overweight: OR, 2.23; 95% CI, 1.42–3.51). Age-stratified analysis showed that among participants aged 31–50 years, those that ate away from home ≥ 3 times a week were 3.53 times more likely to be obese than those that ate away from home less than once/week (OR, 3.53; 95% CI, 1.69–7.37).CONCLUSIONSFrequent EAFH was positively associated with overweight and obesity among men, and obesity among young/middle-aged adults, but negatively associated with overweight in women. Nutritional interventions for obesity reduction in Uganda should include strategies aimed at reducing the frequency of eating meals prepared away from home, and specifically target men and young/middle-aged adults.