title: Healthcare utilization associated with obesity and physical disabilities.
abstract: BACKGROUND
  Obesity incurs a substantial economic burden to healthcare systems. Little is known about the combined medical costs attributable to obesity among individuals with physical disabilities (PDs).
  
  
  OBJECTIVE
  To estimate the annual healthcare utilization and expenditure associated with overweight and obesity among adults with and without PDs.
  
  
  METHODS
  Weighted multivariate generalized linear models were used to estimate healthcare costs and utilization among adults with and without PDs, across standard BMI categories, using the 2002-2011 Medical Expenditure Panel Survey. The analyses, performed in 2013-2014, included a population representative sample of 215,107 individuals, aged ≥18 years. Overall, 36,349 adults reported moderate or significant PDs. The primary outcomes were total healthcare costs, physician office visits, and hospitalization.
  
  
  RESULTS
  After adjusting for sociodemographic variables, self-rated mental and physical health, physical activity, and year, adults with PDs incurred more than 1.96 times the adjusted total healthcare costs ($4,298, 95% CI=$3,980, $4,617) than adults without PDs. Obese individuals spent significantly more than those at normal weight ($726, p<0.001). Obese individuals with PDs spent 1.13 times more than normal-weight individuals with PDs ($1,107, p<0.001) and >2.2 times more than normal-weight individuals without PDs ($5,197, p<0.001). PDs plus obesity represents $23.9 billion/year, or roughly 50% of the total costs attributable to obesity in the U.S.
  
  
  CONCLUSIONS
  Across BMI categories, there was significantly greater healthcare utilization and cost among adults with PDs, independent of age, race, education, and SES. Health policies need to identify behavioral interventions that address both healthy weight achievement/maintenance and functional independence among all adults.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Peterson
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, Michigan. Electronic address: mahmoudi@med.umich.edu.
authors.forename: Elham
authors.initials: E
authors.lastname: Mahmoudi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000191:economics*; D014481:United States