Impact of cardiovascular risk factors on medical expenditure: evidence from epidemiological studies analysing data on health checkups and medical insurance

Impact of weight loss on obesity-related complications and direct healthcare costs in Japan: A modelling study

AIM

Body mass index (BMI) in Japan has increased over the past decades, leading to corresponding increases in the risks of complications such as type 2 diabetes (T2D). We modelled the impact of weight loss on the incidence of 10 specific complications and resulting healthcare costs in a Japanese cohort.

MATERIALS AND METHODS

We adapted our value of weight loss simulation model to represent a cohort of 100,000 Japanese individuals aged 20-69 years with a BMI of 25-50 kg/m2. Complication prevalence data were from the Medical Data Vision electronic health record database, and costs were identified using a targeted literature review and the IQVIA claims database. The impact of weight loss was modelled from 2024 to 2029.

RESULTS

Total estimated direct medical costs associated with complications were 171.7 million US dollars (USD) or 25.6 billion Japanese yen (JPY) in 2024, projected to increase to 234.9 million USD (35.1 billion JPY) by 2029. A 10% or 15% lower weight across the population was estimated to be associated with a lower incidence of all complications, particularly sleep apnoea, T2D and hypertension. The resulting estimated cumulative cost reductions amounted to 34.6 million USD (5.2 billion JPY) for a 10% weight loss and 47.7 million USD (7.1 billion JPY) for a 15% weight loss over 5 years, largely arising from reductions in T2D.

CONCLUSIONS

Weight loss in the Japanese population has the potential to drive major reductions in healthcare costs via prevention of complications associated with higher BMI and consequent reductions in costs associated with these complications. Greater weight loss is likely to be associated with greater cost reductions. Our analysis highlights the importance of prompt weight management support for people living with obesity.

Comprehensive assessment of molecular function, tissue characterization, and hemodynamic performance by non-invasive hybrid imaging: Potential role of cardiac PETMR

Noninvasive cardiovascular imaging plays a key role in diagnosis and patient management including monitoring treatment efficacy. The usefulness of noninvasive cardiovascular imaging has been extensively studied and shown to have high diagnostic reliability and prognostic significance, while the nondiagnostic results frequently encountered with single imaging modality require complementary or alternative imaging techniques. Hybrid cardiac imaging was initially introduced to integrate anatomical and functional information to enhance the diagnostic performance, and lately employed as a strategy for comprehensive assessment of the underlying pathophysiology of diseases. More recently, the utility of computed tomography has grown in diversity, and emerged from being an exploratory technique allowing functional measurement such as stress dynamic perfusion. Cardiac magnetic resonance imaging (CMR) is widely accepted as a robust tool for evaluation of cardiac function, fibrosis, and edema, yielding high spatial resolution and soft-tissue contrast. However, the use of intravenous contrast materials is typically required for accurate diagnosis with these imaging modalities, despite the associated risk of renal toxicity. Nuclear cardiology, established as a molecular imaging technique, has advantages in visualization of the disease-specific biological process at cellular level using numerous probes without requiring contrast materials. Various imaging modalities should be appropriately used sequentially to assess concomitant disease and the progression over time. Therefore, simultaneous evaluation combining high spatial resolution and disease-specific imaging probe is a useful approach to identify the regional activity and the stage of the disease. Given the recent advance and potential of multiparametric CMR and novel nuclide tracers, hybrid positron emission tomography MR is becoming an ideal tool for disease-specific imaging.

Effects of real-time remote cardiac rehabilitation on exercise capacity and quality of life: a quasi-randomised controlled trial

BACKGROUND

The impact of real-time remote cardiac rehabilitation (CR) on health and disability-related outcomes and its correlation with physical function are unknown. We compared the effectiveness of real-time remote CR with that of hospital-based CR on physical function improvement and physical functions of improvement (Δ) to clarify the relationship between health and disability at baseline.

METHODS

Patients with cardiovascular diseases (CVDs) were enrolled (n = 38) in this quasi-randomised controlled trial and underwent 4 weeks of hospital-based CR, followed by 12 weeks of remote or hospital-based CR based on quasi-randomised allocation. Patients were assessed at baseline and after 12 weeks of remote or hospital-based CR using the shortened version of the World Health Organization (WHO) Quality of Life scale (WHOQOL-BREF) for subjective satisfaction, WHO Disability Assessment Schedule (WHODAS2.0-J) for objective performance, and cardiopulmonary exercise test for physical function and peak oxygen uptake (peak VO2). The trends in measured variables from baseline to the post-CR stage were analysed.

RESULTS

Sixteen patients (mean age, 72.2 ± 10.4 years) completed remote CR, and 15 patients (mean age, 77.3 ± 4.8 years) completed hospital-based CR. The post-CR physical function differed significantly between the groups (Δpeak VO2, 2.8 ± 3.0 versus 0.84 ± 1.8 mL·min-1·kg-1; p < 0.05). The differences in post-CR changes in the WHOQOL-BREF scores between the groups were insignificant. The post-CR changes in the WHODAS2.0-J scores were significantly lower in the remote CR group than in the hospital-based CR group (ΔWHODAS2.0-J score, -8.56 ± 14.2 versus 2.14 ± 7.6; p < 0.01). Forward multiple stepwise regression analysis using overall data showed that the intervention method (β = 0.339, p < 0.05), baseline cognition (β =  - 0.424, p < 0.05), and social interaction level (β = 0.658, p < 0.01; WHODAS2.0-J) were significant independent contributors to Δpeak VO2 (r2 = 0.48, F = 8.13, p < 0.01).

CONCLUSIONS

Remote CR considerably improved physical function and objective performance in patients with CVDs. Remote CR can be used to effectively treat stable patients who cannot visit hospitals.

TRIAL REGISTRATION

This interventional trial was registered at the UMIN-CTR registry (trial title: Development of remote programme for cardiac rehabilitation using wearable electrocardiograph; trial ID: UMIN000041746; trial URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046564 ; registration date: 2020/09/09).

Economic burden of comorbid chronic conditions among survivors of stroke in China: 10-year longitudinal study

Background

The coexistence of chronic diseases among people with stroke is common. However, little is known about the extent of incremental healthcare expenditures associated with having physically and psychologically chronic conditions among stroke survivors.

Methods

We used the nationally representative data from the China Health and Nutrition Survey, including 36,076 participants enrolled as our analytic cohort of ten years of follow-up visits (2006, 2009, 2011, 2015). Chronic conditions include hypertension, diabetes, obesity, and impaired cognitive function. Two-part models were used to estimate the effect of comorbid chronic conditions on total annual healthcare expenditure, out-of-pocket (OOP) healthcare expenditure, and incidence of catastrophic healthcare expenditure (CHE).

Results

Among survivors of stroke during 2006 to 2015, the prevalence rates of hypertension, diabetes, obesity and impaired cognitive function were 75.5, 9.8, 12.7 and 65.1%, significantly higher than those among adults without stroke history (27.9, 2.7, 10.0 and 41.2%). Having hypertension ($794.5, p = 0.004), diabetes ($3978.5, p < 0.001) were associated with the largest incremental total healthcare expenditures. Stroke survivors with diagnosed hypertension and diabetes had additional 5.7 (p < 0.001) and 10.4 (p < 0.001) percentage point of CHE rate, respectively. Total healthcare expenditures were $2413.0 (P < 0.001) and $5151.7 (P < 0.001) higher among patients with 2, and ≥ 3 chronic conditions, respectively, than those individuals with no chronic conditions.

Conclusions

Excess expenditures associated with chronic diseases were substantial among stroke survivors. These results highlight the needs for both prevention and better management of multimorbidity among stroke survivors, which in turn may lower the financial burden of treating these concurrent comorbidities.

Cardiovascular and cerebrovascular diseases risk associated with the incidence of presenteeism and the costs of presenteeism

Objectives

The objective of this study was to estimate a risk of cardiovascular and cerebrovascular diseases for each worker and to determine whether this risk is associated with the incidence and costs of presenteeism, absenteeism, and medical/drug treatments.

Methods

Established risk equations were used to estimate the 10‐year probability of developing coronary artery disease and ischemic stroke in male workers aged 40‐65 years who were recruited from four pharmaceutical companies in Japan. The incidence of presenteeism was defined as existence of presenteeism for the past a month, and the incidence of absenteeism was defined as existence of sick‐leave for the past three months by a self‐administered questionnaire. Each cost was calculated based on the human capital method. Data on medical/drug treatments were collected from health insurance claims.

Results

The risks were calculated for 6047 workers. Individuals at moderate and high risk of coronary artery disease had a significantly higher rate of presenteeism and absenteeism than workers at low risk. Workers at moderate and high risk of ischemic stroke also had a significantly higher rate of presenteeism and absenteeism than workers at low risk. Mean costs for absenteeism and medical/drug treatments increased with the risk of developing coronary artery disease or ischemic stroke, while costs for presenteeism did not.

Conclusions

To prevent the costs of presenteeism, workers not only at high risk but also at low and moderate risk of developing cardiovascular and cerebrovascular diseases should receive health care services.

Combined Associations of Body Mass Index and Metabolic Health Status on Medical and Dental Care Days and Costs in Japanese Male Employees: A 4-Year Follow-Up Study

BACKGROUND

The combined associations of body mass index (BMI) levels and metabolic dysfunction with medical and dental care utilizations is unclear.

METHODS

A 4-year follow-up study was performed in 16,386 Japanese male employees (mean age 48.2 [standard deviation, 11.0] years) without a history of cardiovascular disease (CVD), cancer, or renal failure. They were classified into eight phenotypes based on four BMI levels (underweight, <18.5; normal weight, 18.5-24.9; overweight, 25.0-29.9; and obese, ≥30.0 kg/m²) and the presence or absence of ≥2 of 4 metabolic abnormalities: high blood pressure, high triglycerides, low high-density-lipoprotein cholesterol, and high blood sugar. Based on their health insurance claims data, we compared medical and dental care days and costs among the eight different BMI/metabolic phenotypes during 2010-2013.

RESULTS

The combinations of BMI levels and metabolic status were significantly associated with the adjusted mean and median medical outpatient days and costs and the median dental outpatient days and costs. The obese/unhealthy subjects had the highest medical outpatient days and costs, and the underweight/unhealthy subjects had the highest dental outpatient days and costs. The underweight/unhealthy subjects also had the highest medical inpatient days and hospitalization rates of CVD, and had higher medical costs compared with the obese/healthy subjects. The differences in median medical costs between healthy and unhealthy phenotypes were larger year by year across all BMI levels.

CONCLUSIONS

Identification of obesity phenotypes using both BMI levels (including the underweight level) and metabolic status may more precisely predict healthcare days and costs compared with either BMI or metabolic status alone.

Unhealthy changes in eating habits cause acute onset hypertension in the normotensive community-dwelling elderly-3 years cohort study

The aim of this study was to determine what lifestyle changes can predict acute onset hypertension in the normotensive community-dwelling elderly.This study targeted elderly people enrolled in National Health Insurance in Fukushima Prefecture, Japan. The subjects were 24,490 people who took all of the specific health examination conducted by National Health Insurance in fiscal years 2013, 2014, and 2015 continuously and had a recorded systolic blood pressure (BP) <130 mm Hg and diastolic BP <85 mm Hg in the first 2 fiscal years. We examined their lifestyle changes for the first 2 fiscal years using the questionnaires given at the health examination. Multivariate Poisson regression analysis was conducted to examine the relationship between new-onset hypertension observed at the last examination and unhealthy lifestyle changes.The mean age of the subjects was 61.5 ± 8.2 years old at baseline. We observed new-onset hypertension in 1.062 subjects at the last examination. Of the study subjects, 12,027 (49.1%) answered to having at least one of the items of unhealthy lifestyle change in the questionnaire. In the multivariate logistic regression, eating supper before bedtime showed a significant increase in the risk ratio for acute onset hypertension (risk ratio 1.27, 95% confidence interval, 1.01-1.58).This study indicated that eating before bedtime is a risk factor of new-onset hypertension in the normotensive community-dwelling elderly. Adequate health guidance to avoid unhealthy lifestyle changes is required even in normotensive people as this hypertension is preventable.

Discussion of "Representation of People's Decisions in Health Information Systems: A Complementary Approach for Understanding Health Care Systems and Population Health"

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Representation of People's Decisions in Health Information Systems: A Complementary Approach for Understanding Health Care Systems and Population Health" written by Fernan Gonzalez Bernaldo de Quiros, Adriana Ruth Dawidowski, and Silvana Figar. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the paper of de Quiros, Dawidowski, and Figar. In subsequent issues the discussion can continue through letters to the editor.