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  • 1
    Abstract: Methods: this cross-sectional analysis used data of n = 3,108 individuals aged 58-82 from a population-based prospective cohort study. Body mass index (BMI) and waist-to-height ratio (WHtR) were calculated based on clinical examinations. Health service use was measured by a questionnaire for a 3-month period. Corresponding costs were calculated applying a societal perspective. Results: 21.8% of the sample were normal weight, 43.0% overweight, 25.5% obese class 1 and 9.6% obese class a parts per thousand yen2 according to BMI. In 42.6%, WHtR was a parts per thousand yen0.6. For normal weight, overweight, obese class 1 and obese class a parts per thousand yen2 individuals, mean costs (3-month period) of outpatient care were 384a,not sign, 435a,not sign, 475a,not sign and 525a,not sign (P 〈 0.001), mean costs of inpatient care were 284a,not sign, 408a,not sign, 333a,not sign and 652a,not sign (P = 0.070) and mean total costs 716a,not sign, 891a,not sign, 852a,not sign and 1,244a,not sign (P = 0.013). For individuals with WHtR 〈 0.6 versus a parts per thousand yen0.6, outpatient costs were 401a,not sign versus 499a,not sign (P 〈 0.001), inpatient costs 315a,not sign versus 480a,not sign (P = 0.016) and total costs 755a,not sign versus 1,041a,not sign (P 〈 0.001). Multiple regression analyses controlling for sociodemographic variables showed a significant effect of obesity on costs of outpatient care (class 1: +72a,not sign; class a parts per thousand yen2: +153a,not sign) and total costs (class a parts per thousand yen2: +361a,not sign) while the effect of overweight was not significant. WHtR a parts per thousand yen0.6 significantly increased outpatient costs by +79a,not sign and total costs by +189a,not sign. Conclusions: excess weight is associated with increased service use and cost in elderly individuals, in particular in obese class a parts per thousand yen2 individuals.
    Type of Publication: Journal article published
    PubMed ID: 25829392
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  • 2
    Abstract: Background Cardiovascular disease is a leading cause of death in older people, and the impact of being exposed or not exposed to preventive cardiovascular medicines is accordingly high. Underutilization of beneficial drugs is common, but prevalence estimates differ across settings, knowledge on predictors is limited, and clinical consequences are rarely investigated. Methods Using data from a prospective population-based cohort study, we assessed the prevalence, determinants, and outcomes of medication underuse based on cardiovascular criteria from Screening Tool To Alert to Right Treatment (START). Results Medication underuse was present in 69.1% of 1454 included participants (mean age 71.1 +/- 6.1 years) and was significantly associated with frailty (odds ratio: 2.11 [95% confidence interval: 1.24-3.63]), body mass index (1.03 [1.01-1.07] per kg/m(2)), and inversely with the number of prescribed drugs (0.84 [0.79-0.88] per drug). Using this information for adjustment in a follow-up evaluation (mean follow-up time 2.24 years) on cardiovascular and competing outcomes, we found no association of medication underuse with cardiovascular events (fatal and non-fatal) (hazard ratio: 1.00 [0.65-1.56]), but observed a significant association of medication underuse with competing deaths from non-cardiovascular causes (2.52 [1.01-6.30]). Conclusion Medication underuse was associated with frailty and adverse non-cardiovascular clinical outcomes. This may suggest that cardiovascular drugs were withheld because of serious co-morbidity or that concurrent illness can preclude benefit from cardiovascular prevention. In the latter case, adapted prescribing criteria should be developed and evaluated in those patients.
    Type of Publication: Journal article published
    PubMed ID: 26288222
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