title: Health Care Utilization by Body Mass Index in a Pediatric Population.
abstract: OBJECTIVE
  We tested the hypothesis that the frequency of emergency department (ED) visits, outpatient clinic visits, and hospitalizations were higher among children with higher body mass index (BMI) categories, even after controlling for demographics, socioeconomic status, and presence of other chronic medical conditions.
  
  
  METHODS
  We obtained electronic height, weight, and utilization data for all residents of Olmsted County, Minnesota, aged 2 to 18 years on January 1, 2005 (n = 34,335), and calculated baseline BMI (kg/m(2)). At least 1 BMI measurement and permission to use medical record information was available for 19,771 children (58%); 19,528 with follow-up comprised the final cohort. BMIs were categorized into underweight/healthy weight (<85th percentile), overweight (85th to <95th percentile), and obese (≥95th percentile). Negative binomial models were used to compare the rate of utilization across BMI categories. Multivariable models were used to adjust for the effects of age, race, sex, socioeconomic status, and chronic medical conditions.
  
  
  RESULTS
  Compared to children with BMI <85th percentile, overweight and obese status were associated with increased ED visits (adjusted incident rate ratio [IRR] 1.16, 95% confidence interval [CI] 1.10, 1.23; and IRR 1.27, 95% CI 1.19, 1.35, respectively; P for trend <.0001), and outpatient clinic visits (IRR 1.05, 95% CI 1.02, 1.08; and IRR 1.07, 95% CI 1.04, 1.11, respectively; P for trend <.0001). No associations were observed between baseline BMI category and hospitalizations in the adjusted analyses.
  
  
  CONCLUSIONS
  Children who are overweight or obese utilize the ED and outpatient clinics more frequently than those who are underweight/healthy weight, but are not hospitalized more frequently.
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn. Electronic address: lynch.brian@mayo.edu.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Lynch
authors.affiliation: Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, Rochester, Minn; Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
authors.forename: Lila J
authors.initials: LJ
authors.lastname: Finney Rutten
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, Rochester, Minn.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Jacobson
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Seema
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Muhamad Y
authors.initials: MY
authors.lastname: Elrashidi
authors.affiliation: Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, Rochester, Minn.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Wilson
authors.affiliation: Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, Rochester, Minn; Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Jacobson
authors.affiliation: Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, Rochester, Minn; Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: St Sauver
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D013851:Thinness / Q000453:epidemiology*
keywords: adolescent; child; emergency service; health services utilization; hospital utilization; obesity; pediatric obesity; preschool