title: Joint impact of health risks on health care charges: 7-year follow-up of National Health Insurance beneficiaries in Japan (the Ohsaki Study).
abstract: BACKGROUND
  The objective of this study was to examine the joint impact of modifiable health-risk factors such as smoking, obesity, and physical inactivity on direct health care charges.
  
  
  METHODS
  We conducted a population-based prospective cohort study, with follow-up from 1995 to 2001. The participants were Japanese National Health Insurance (NHI) beneficiaries (26,110 men and women aged 40-79 years).
  
  
  RESULTS
  'No risk' group defined as never-smoking, body mass index (BMI) 20.0-24.9 kg/m(2), and walking for >/=1 h/day had mean health care charges of 171.6 dollars after adjustment for potential confounders. Compared with this group, the presence of smoking (SM; ever-smoking) alone, obesity alone (OB; BMI >/=25.0 kg/m(2)), or physical inactivity (PI; walking for <1 h/day) alone were associated with a 8.3%, 7.1%, or 8.0% increase in health care charges, respectively. The combinations of the risks of SM and OB, SM and PI, OB and PI, and SM and OB and PI were associated with a 11.7%, 31.4%, 16.4%, and 42.6% increase in charges, respectively.
  
  
  CONCLUSIONS
  Interventions to improve modifiable health-risk factors may be a cost-effective approach for reducing health care charges as well as improving people's health.
authors.affiliation: Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. kuriyama-thk@umin.ac.jp
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kuriyama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hozawa
authors.forename: Kaori
authors.initials: K
authors.lastname: Ohmori
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Nishino
authors.forename: Kazuki
authors.initials: K
authors.lastname: Fujita
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Tsubono
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tsuji
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000191:economics*; D015444:Exercise / Q000502:physiology; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D007564:Japan; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data; D009765:Obesity / Q000191:economics; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000191:economics