Health service utilization and direct healthcare costs associated with obesity in older adult population in Ghana

Lartey, Stella T. ORCID:, de Graaff, Barbara, Magnussen, Costan G., Boateng, Godfred O., Aikins, Moses, Minicuci, Nadia, Kowal, Paul, Si, Lei and Palmer, Andrew J. (2020) Health service utilization and direct healthcare costs associated with obesity in older adult population in Ghana. Health Policy and Planning, 35 (2). pp. 199-209. ISSN 0268-1080

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Obesity is a major risk factor for many chronic diseases and disabilities, with severe implications on morbidity and mortality among older adults. With an increasing prevalence of obesity among older adults in Ghana, it has become necessary to develop cost-effective strategies for its management and prevention. However, developing such strategies is challenging as body mass index (BMI)-specific utilization and costs required for cost-effectiveness analysis are not available in this population. Therefore, this study examines the associations between health services utilization as well as direct healthcare costs and overweight (BMI ≥25.00 and <30.00 kg/m2) and obesity (BMI ≥30.00 kg/m2) among older adults in Ghana. Data were used from a nationally representative, multistage sample of 3350 people aged 50+ years from the World Health Organization's Study on global AGEing and adult health (WHO-SAGE; 2014/15). Health service utilization was measured by the number of health facility visits over a 12-month period. Direct costs (2017 US dollars) included out-of-pocket payments and the National Health Insurance Scheme (NHIS) claims. Associations between utilization and BMI were examined using multivariable zero-inflated negative binomial regressions; and between costs and BMI using multivariable two-part regressions. Twenty-three percent were overweight and 13% were obese. Compared with normal-weight participants, overweight and obesity were associated with 75% and 159% more inpatient admissions, respectively. Obesity was also associated with 53% additional outpatient visits. One in five of the overweight and obese population had at least one chronic disease, and having chronic disease was associated with increased outpatient utilization. The average per person total costs for overweight was $78 and obesity was $132 compared with $35 for normal weight. The NHIS bore approximately 60% of the average total costs per person expended in 2014/15. Overweight and obese groups had significantly higher total direct healthcare costs burden of $121 million compared with $64 million for normal weight in the entire older adult Ghanaian population. Compared with normal weight, the total costs per person associated with overweight increased by 73% and more than doubled for obesity. Even though the total prevalence of overweight and obesity was about half of that of normal weight, the sum of their cost burden was almost doubled. Implementing weight reduction measures could reduce health service utilization and costs in this population.

Item Type: Article
Additional Information: Acknowledgements: The authors appreciate access to a preliminary version of SAGE Ghana Wave 2 data used for the analyses in this manuscript and acknowledge the Ghana WHO-SAGE Team. They also acknowledge Prof. Leigh Blizzards of Menzies Institute for Medical Research, University of Tasmania for the statistical advise he provided regarding the data curation and analyses. Prof. A.J.P. is funded by the Centre of Excellence in Population Ageing Research, Australian Research Council (CE170100005). The National Heart Foundation of Australia Future Leader Fellowship (100849) supports Dr. C.G.M. Dr. L.S. is supported by a NHMRC Early Career Fellowship (Grant number: GNT1139826). Dr. B.d.G. is funded by the Menzies Community Fellowship. The Study on global AGEing and adult health (SAGE) Wave 2 was supported by WHO and the US National Institute on Aging’s Division of Behavioural and Social Science Research (BSR) through Interagency Agreements (OGHA 04034785; YA1323-08-CN-0020; Y1-AG-1005-01) with WHO. Financial and in-kind support has come from the University of Ghana’s Department of Community Health.
Uncontrolled Keywords: direct healthcare costs,ghana,health service utilization,obesity,older adults,who-sage wave 2,health policy,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2719
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Science > Research Groups > Norwich Epidemiology Centre
Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre
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Depositing User: LivePure Connector
Date Deposited: 18 Aug 2022 13:31
Last Modified: 07 Apr 2024 00:49
DOI: 10.1093/heapol/czz147

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