Peer Reviewed: Health Care Costs and Participation in a Community-Based Health Promotion Program for Older Adults

Introduction

EnhanceWellness (EW) is a community-based health promotion program that helps prevent disabilities and improves health and functioning in older adults. A previous randomized controlled trial demonstrated a decrease in inpatient use for EW participants but did not evaluate health care costs. We assessed the effect of EW participation on health care costs.

Methods

We performed a retrospective cohort study in King County, Washington. Enrollees in Group Health Cooperative (GHC), a mixed-model health maintenance organization, who were aged 65 years or older and who participated in EW from 1998 through 2005 were matched 1:3 by age and sex to GHC enrollees who did not participate in EW. We matched 218 EW participants by age and sex to 654 nonparticipants. Participants were evaluated for 1 year after the date they began the program. The primary outcome was total health care costs; secondary outcomes were inpatient costs, primary care costs, percentage of hospitalizations, and number of hospital days. We compared postintervention outcomes between EW participants and nonparticipants by using linear regression. Results were adjusted for prior year costs (or health care use), comorbidity, and preventive health care-seeking behaviors.

Results

Mean age of participants and nonparticipants was 79 years, and 72% of participants and nonparticipants were female. Adjusted total costs in the year following the index date were $582 lower among EW participants than nonparticipants, but this difference was not significant.

Conclusion

Although EW participation demonstrated health benefits, participation does not appear to result in significant health care cost savings among people receiving health care through a health maintenance organization.     

Peer Reviewed: Prevalence of Self-Reported Prediabetes Among Adults Participating in a Community-Based Health Awareness Program,New York State

Introduction

The purpose of this study was to assess crude, age-adjusted, and risk-factor–specific prevalences of self-reported prediabetes and to identify factors associated with self-reported prediabetes in an adult population.

Methods

Data were collected through questionnaires completed by a racially diverse sample of diabetes-free adult participants in the statewide community-based wellness and diabetes awareness program in New York State during 2006 (N = 2,572). Prediabetes was determined by the affirmative answer to the question, "Have you ever been told by a doctor that you have prediabetes?"

Results

The overall crude prevalence of self-reported prediabetes was 9.1%, and the age-adjusted prevalence was 7.6%. The age-adjusted prevalence of prediabetes was significantly lower among non-Hispanic blacks (4.2%) and significantly higher among American Indians (22.4%), compared with the prevalence among non-Hispanic whites (7.3%). The prevalence of self-reported prediabetes was uniformly higher among older (aged ≥45 years) adults than younger (aged <45 years) adults, overall and in each racial/ethnic group. In all age and racial/ethnic groups, the prevalence significantly increased with the number of additional risk factors. The best fit multivariate logistic regression model identified that self-reported prediabetes was associated with family history of diabetes (odds ratio [OR], 3.65), body mass index 25.0 kg/m² or higher (OR, 2.79), age 45 years or older (OR, 2.77), and having health insurance (OR, 2.38).

Conclusion

This study found that adults who were at high risk for diabetes and had health insurance were more likely to report having prediabetes. Community-based diabetes prevention needs to consider strategies to increase detection of prediabetes in high-risk uninsured people and to raise general awareness of prediabetes.     

Peer Reviewed: Obesity and Obesity-Related Comorbidities in a Canadian First Nation Population

Introduction

Rates of obesity are higher among Canada''s Aboriginal First Nations populations than among non-First Nations populations. We studied obesity and obesity-related illness in a Manitoba First Nation community.

Methods

We conducted a screening study of diabetes and diabetes complications in 2003, from which we drew a representative sample of Manitoba First Nations adults (N = 483). We assessed chronic disease and chronic disease risk factors.

Results

Prevalence of obesity and associated comorbidities was higher among women than men. By using multivariate analysis, we found that factors significantly associated with obesity among women were diastolic blood pressure, insulin resistance, and employment status. Among men, factors were age, apolipoprotein A1 level, apolipoprotein B level, and insulin resistance. Seventy-five percent of study participants had at least 1 of the following conditions: obesity, dyslipidemia, hypertension, or diabetes. Comorbidity was high even among the youngest age groups; 22% of men and 43% of women aged 18 to 29 had 2 or more chronic conditions. Twenty-two percent of participants had undiagnosed hypertension. Participants with undiagnosed hypertension had significantly more chronic conditions and were more likely to have microalbuminuria than were those without hypertension. The number of chronic conditions was not significantly different for participants with newly diagnosed hypertension than for those with previously diagnosed hypertension.

Conclusions

The prevalence of obesity and other chronic conditions in the study community is high, especially considering the number of young people. Community-based interventions are being undertaken to reduce the excessive rate of illness.     

Peer Reviewed: Validity of Self-Reported Height,Weight, and Body Mass Index: Findings from the National Health and Nutrition Examination Survey, 2001-2006

Introduction

Our study extends previous studies that have evaluated the level of bias in self-reported height and weight and corresponding body mass index (BMI). Results are evaluated by age, sex, income, race/ethnicity, and BMI classifications.

Methods

Analyses are based on the National Health and Nutrition Examination Survey (NHANES) from 2001-2006. The sample was 8,208 men and 8,606 women aged 16 years or older.

Results

On average, men overreport their height by 1.22 cm (0.48 in) and their weight by 0.30 kg (0.66 lbs), and women overreport their height by 0.68 cm (0.27 in) and underreport their weight by −1.39 kg (−3.06 lbs). Overreporting of height significantly increases with age after age 50 for men and after age 60 for women. Overreporting of weight in men is significant in the age groups 16 to 49 years and 70 years or older. Women significantly underreport their weight in each age group but more so in the age group 16 to 49 years, followed by 50 to 69 years, and then 70 years or older. Men are more likely than women to think their weight is about right if they are at a normal weight or are overweight or obese, but women are more likely to think their weight is about right if they are underweight.

Conclusion

Men and women significantly overreport their height, increasingly so at older ages. Men tend to overestimate their weight, but women underreport their weight, more so in younger ages. Corresponding BMI is underestimated, more so for women than for men at each age and increasingly so with older age for both sexes.     

Peer Reviewed: Arthritis in the Canadian Aboriginal Population: North-South Differences in Prevalence and Correlates

Background

Information on arthritis and other musculoskeletal disorders among Aboriginal people is sparse. Survey data show that arthritis and rheumatism are among the most commonly reported chronic conditions and their prevalence is higher than among non-Aboriginal people.

Objective

To describe the burden of arthritis among Aboriginal people in northern Canada and demonstrate the public health significance and social impact of the disease.

Methods

Using cross-sectional data from more than 29 000 Aboriginal people aged 15 years and over who participated in the Aboriginal Peoples Survey 2006, we assessed regional differences in the prevalence of arthritis and its association with other risk factors, co-morbidity and health care use.

Results

The prevalence of arthritis in the three northern territories ("North") is 12.7% compared to 20.1% in the provinces ("South") and is higher among females than males in both the North and South. The prevalence among Inuit is lower than among other Aboriginal groups. Individuals with arthritis are more likely to smoke, be obese, have concurrent chronic diseases, and are less likely to be employed. Aboriginal people with arthritis utilized the health care system more often than those without the disease.

Conclusion:

Aboriginal-specific findings on arthritis and other chronic diseases as well as recognition of regional differences between North and South will enhance program planning and help identify new priorities in health promotion.

Keywords

arthritis, Aboriginal people, Northern Canada, Inuit, First Nations, Métis, North American Indians, Aboriginal Peoples Survey     

Peer Reviewed: Cardiovascular Risk According to Plasma Apolipoprotein and Lipid Profiles in a Canadian First Nation

Introduction

Despite high diabetes rates among Canadian First Nations people, little is known about their cardiovascular disease risk. Our aim was to describe the apolipoprotein profile with respect to cardiovascular risk in a Canadian First Nation community.

Methods

In 2003, a representative sample of adult members of a Manitoba First Nation (N = 483) participated in a screening study for diabetes and diabetes complications. We assessed their cardiovascular risk factors.

Results

Sixty percent of women were at increased cardiovascular risk because of low apolipoprotein A1 (apoA1) levels, compared with 35% of men. The proportion of women with low apoA1 levels decreased with age, but the proportion with low high-density lipoprotein levels remained stable across age groups. Both apoB and apoA1 were significantly associated with obesity when age, sex, diastolic blood pressure, homocysteine, diabetes, and insulin resistance were controlled for.

Conclusion

Apolipoprotein and lipid profiles in this First Nation population suggest high cardiovascular risk. Future research should characterize the lipoprotein particle size in this population.     

Peer Reviewed: Identifying Adolescent Metabolic Syndrome Using Body Mass Index and Waist Circumference

Introduction

Metabolic syndrome is increasing among adolescents. We examined the utility of body mass index (BMI) and waist circumference to identify metabolic syndrome in adolescent girls.

Methods

We conducted a cross-sectional analysis of 185 predominantly African American girls who were a median age of 14 years. Participants were designated as having metabolic syndrome if they met criteria for 3 of 5 variables: 1) high blood pressure, 2) low high-density lipoprotein cholesterol level, 3) high fasting blood glucose level, 4) high waist circumference, and 5) high triglyceride level. We predicted the likelihood of the presence of metabolic syndrome by using previously established cutpoints of BMI and waist circumference. We used stepwise regression analysis to determine whether anthropometric measurements significantly predicted metabolic syndrome.

Results

Of total participants, 18% met the criteria for metabolic syndrome. BMI for 118 (64%) participants was above the cutpoint. Of these participants, 25% met the criteria for metabolic syndrome, whereas only 4% of participants with a BMI below the cutpoint met the criteria for metabolic syndrome (P <.001). Girls with a BMI above the cutpoint were more likely than girls with a BMI below the cutpoint to have metabolic syndrome (P = .002). The waist circumference for 104 (56%) participants was above the cutpoint. Of these participants, 28% met the criteria for metabolic syndrome, whereas only 1% of participants with a waist circumference below the cutpoint met the criteria for metabolic syndrome (P <.001). Girls with a waist circumference above the cutpoint were more likely than girls with a waist circumference below the cutpoint to have metabolic syndrome (P = .002). Stepwise regression showed that only waist circumference significantly predicted metabolic syndrome.

Conclusion

Both anthropometric measures were useful screening tools to identify metabolic syndrome. Waist circumference was a better predictor of metabolic syndrome than was BMI in our study sample of predominantly African American female adolescents living in an urban area.     

Self-Reported Height,Calculated Height,and Derived Body Mass Index in Assessment of Older Adults

Body mass index (BMI) is frequently used as assessment of nutritional and health risk. Yet, there is no consensus regarding assessment of height and cutpoints for weight classification in older adults. We first investigated differences in height by self-report (SR-height) and height calculated from measured knee-height (KH-height) and derived BMI in a cross-sectional assessment of 145 older adults residing in a Midwestern United States city. We further compared the proportion of older adults classified as at risk by seven different BMI cutpoints for weight classification as reported in the literature. We found no substantive difference in SR-height and KH-height or derived BMI, but we did find significant differences in the proportions of participants classified as At Risk across different BMI cutpoints. In community and clinical practice, SR-height and KH-height, and BMI derived from these, can be used interchangeably, but the lack of consensus regarding BMI cutpoints could lead to misclassification of older adults at risk.     

Peer Reviewed: Commute Times,Food Retail Gaps,and Body Mass Index in North Carolina Counties

Introduction

The prevalence of obesity is higher in rural than in urban areas of the United States, for reasons that are not well understood. We examined correlations between percentage of rural residents, commute times, food retail gap per capita, and body mass index (BMI) among North Carolina residents.

Methods

We used 2000 census data to determine each county''s percentage of rural residents and 1990 and 2000 census data to obtain mean county-level commute times. We obtained county-level food retail gap per capita, defined as the difference between county-level food demand and county-level food sales in 2008, from the North Carolina Department of Commerce, and BMI data from the 2007 North Carolina Behavioral Risk Factor Surveillance System. To examine county-level associations between BMI and percentage of rural residents, commute times, and food retail gap per capita, we used Pearson correlation coefficients. To examine cross-sectional associations between individual-level BMI (n = 9,375) and county-level commute times and food retail gap per capita, we used multilevel regression models.

Results

The percentage of rural residents was positively correlated with commute times, food retail gaps, and county-level BMI. Individual-level BMI was positively associated with county-level commute times and food retail gaps.

Conclusions

Longer commute times and greater retail gaps may contribute to the rural obesity disparity. Future research should examine these relationships longitudinally and should test community-level obesity prevention strategies.     

Peer Reviewed: State Requirements and Recommendations for School-Based Screenings for Body Mass Index or Body Composition, 2010

Introduction

We present a comprehensive picture of state requirements and recommendations for body mass index (BMI) and body composition screening of children and explore the association between pediatric obesity prevalence and state screening policies.

Methods

Researchers completed telephone interviews with contacts at the departments of education for all 50 states and reviewed state content standards for physical education.

Results

Twenty states (40%) require BMI or body composition screening, and 9 states (18%) recommend BMI screening or a formal fitness assessment that includes a body composition component. The prevalence of adolescent obesity was higher in states that require BMI screening or fitness assessments with body composition than in states without requirements (16.7% vs 13.6%, P = .001).

Conclusion

Future studies should evaluate the effect and cost-effectiveness of BMI and body composition screening on child obesity.     

济南市7岁儿童BMI及体成分与血压水平的相关性分析

目的阐明儿童期BMI及体成分指数与血压水平的相关性,为成年期疾病的早期预防提供相关依据。方法对济南市910名7岁儿童进行身高、体重、血压和皮褶厚度测量,采用回归方程推算体脂比(BF%),计算脂肪组织指数(FMI)和非脂肪组织指数(FFMI)。结果 BMI,BF%,FMI,FFMI与收缩压和舒张压均呈一定程度正相关(P值均0.05),血压与FMI的相关性高于FFMI。高BMI、BF%百分位数组儿童的血压水平均显著高于低百分位数组(P值均0.05)。血压偏高的检出率为肥胖组超重组正常组消瘦组。结论儿童BMI及体成分指数与血压水平有显著的相关性。预防儿童高血压应从控制体脂肪、预防肥胖做起。     

儿童青少年体质量指数和腰围与血压的关系

目的探讨儿童青少年体质量指数、腰围与血压的关系,为儿童肥胖的干预提供依据。方法选择北京市3所中学和2所小学,根据2005-2006年中小学生体检身高、体重结果,筛选体重正常、超重和肥胖学生,再对自愿参加的1082名7～15岁学生进行身高、体重、腰围和血压的测量。结果男、女儿童血压及血压偏高检出率均为肥胖儿童〉超重儿童〉体重正常儿童;腰围偏高组也明显高于腰围正常组儿童,差异均有统计学意义（P值均〈0.01）。BMI,WC与儿童SBP,DBP存在明显的正相关关系。结论定期检查超重、肥胖儿童的血压,对预防和控制肥胖儿童高血压的发生具有重要意义。     

体质指数对血压、血糖、血脂的影响

目的 探讨超重、肥胖对血压、血糖、血脂的影响.方法 对2009年医院体检中心1017名健康体检人群的体质指数(BMI)、血压、血糖、血脂等结果 进行统计分析.结果 超重检出率31.37%,肥胖检出率4.92%;随BMI升高,高密度脂蛋白胆固醇水平减低,收缩压、舒张压、空腹血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平逐渐升高,高血压、高血糖、高血脂检出率亦增高.结论 健康体检人群超重、肥胖率较高,超重、肥胖与高血压、高血糖、高血脂关系密切,需采取早期有效措施控制超重和肥胖倾向.     

Body Mass Index,Waist-circumference and Cardiovascular Disease Risk Factors in Iranian Adults: Isfahan Healthy Heart Program

Considering the main effect of obesity on chronic non-communicable diseases, this study was performed to assess the association between body mass index (BMI), waist-circumference (WC), cardiometabolic risk factors and to corroborate whether either or both BMI and WC are independently associated with the risk factors in a sample of Iranian adults. This cross-sectional study was performed on data from baseline survey of Isfahan Healthy Heart Program (IHHP). The study was done on 12,514 randomly-selected adults in Isfahan, Najafabad and Arak counties in 2000-2001. Ages of the subjects were recorded. Fasting blood glucose (FBG), 2-hour post-load glucose (2hpp), serum lipids, systolic and diastolic blood pressure (SBP and DBP), BMI, WC, smoking status, and total daily physical activity were determined. Increase in BMI and WC had a significant positive relation with the mean of FBG, 2hpp, SBP, DBP, serum lipids, except for HDL-C (p<0.001 for all). After adjustment for age, smoking, physical activity, socioeconomic status (SES), and BMI, the highest odds ratio (OR) (95% CI) for diabetes mellitus (DM) according to WC was 3.13 (1.93-5.08) and 1.99 (1.15-3.44) in women and men respectively. Moreover, the highest ORs based on BMI with adjustment for age, smoking, physical activity, SES, and WC were for dyslipidaemia (DLP) [1.97 (1.58-2.45) in women and 2.96 (2.41-3.63) in men]. The use of BMI or WC alone in the models caused to enhance all ORs. When both BMI and WC were entered in the model, the ORs for all risk factors, in men, according to BMI, were more compared to WC. However, in women, ORs for DM and hypertension (HTN) in WC quartiles were more than in BMI quartiles. BMI is the better predictor of DM, HTN, and DLP in men compared to WC. Conversely, in women, WC is a superior predictor than BMI, particularly for DM and HTN. Furthermore, the measurement of both WC and BMI in Iranian adults may be a better predictor of traditional risk factors of CVDs compared to BMI or WC alone.Key words: Body mass index, Diabetes mellitus, Dyslipidaemia, Hypertension, Obesity, Risk Factor, Waist-circumference, Iran     

Peer Reviewed: Managed-Medicare Health Club Benefit and Reduced Health Care Costs Among Older Adults

Introduction

Our study was undertaken to determine the association between use of a health plan-sponsored health club benefit by older adults and total health care costs over 2 years.

Methods

This retrospective cohort study used administrative and claims data from a Medicare Advantage plan. Participants (n = 4766) were enrolled in the plan for at least 1 year before participating in the plan-sponsored health club benefit (Silver Sneakers). Controls (n = 9035) were matched to participants by age and sex according to the index date of Silver Sneakers enrollment. Multivariate regression models were used to estimate health care use and costs and to make subgroup comparisons according to frequency of health club visits.

Results

Compared with controls, Silver Sneakers participants were older and more likely to be male, used more preventive services, and had higher total health care costs at baseline. Adjusted total health care costs for Silver Sneakers participants and controls did not differ significantly in year 1. By year 2, compared with controls, Silver Sneakers participants had significantly fewer inpatient admissions (−2.3%, 95% confidence interval, −3.3% to −1.2%; P < .001) and lower total health care costs (−$500; 95% confidence interval, −$892 to −$106; P = .01]. Silver Sneakers participants who averaged at least two health club visits per week over 2 years incurred at least $1252 (95% confidence interval, −$1937 to −$567; P < .001) less in health care costs in year 2 than did those who visited on average less than once per week.

Conclusion

Regular use of a health club benefit was associated with slower growth in total health care costs in the long term but not in the short term. These findings warrant additional prospective investigations to determine whether policies to offer health club benefits and promote physical activity among older adults can reduce increases in health care costs.