title: Incremental hospital charges associated with obesity as a secondary diagnosis in children.
abstract: OBJECTIVE
  The objective was to evaluate the association of obesity as a comorbidity with hospital charges, by comparing charges for pediatric hospitalizations with vs. without obesity as a secondary diagnosis.
  
  
  METHODS
  Using the 2000 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID), a nationally representative sample of pediatric hospital discharges, we identified the most common non-pregnancy-related principal diagnoses for children 2 to 18 years of age: asthma, pneumonia, affective disorders, and appendicitis. For each we compared mean charges and mean length of stay for hospitalizations with vs. without obesity as a secondary diagnosis, adjusting for relevant socio-demographics and hospital type.
  
  
  RESULTS
  Among children's discharges in 2000, 1.1% listed obesity as a secondary diagnosis. These had a disproportionate likelihood of being older, black, Medicaid beneficiaries, and hospitalized at a general hospital. Adjusted mean hospital charges were significantly higher for discharges with obesity as a secondary diagnosis vs. those without: appendicitis ($14,134 vs. $11,049; p<0.01), asthma ($7766 vs. $6043; p<0.05), pneumonia ($12,228 vs. $9688; p<0.05), and affective disorders ($8292 vs. $7769; p<0.01). Whereas obesity as a secondary diagnosis was associated with a pattern of increased adjusted mean length of stay, only asthma and affective disorders had statistically significant differences (0.6 days) (p<0.01).
  
  
  CONCLUSIONS
  This national analysis suggests obesity as a secondary diagnosis is associated with significantly higher charges for the most common reasons for pediatric hospitalizations. This presents a financial imperative for further research to evaluate factors that contribute to higher inpatient charges related to obesity as a comorbidity and underscores the need for obesity prevention initiatives.
authors.affiliation: Research Unit, Gerald R. Ford School of Public Policy, University of Michigan, 300 NIB, Room 6D22, Campus Box 0456, Ann Arbor, MI 48109-0456, USA. swoolfor@med.umich.edu
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Woolford
authors.forename: Achamyeleh
authors.initials: A
authors.lastname: Gebremariam
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Clark
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D002648:Child; D002673:Child, Hospitalized / Q000193:education / Q000706:statistics & numerical data*; D002675:Child, Preschool; D017281:Cost of Illness; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008824:Michigan / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology*