title: Direct health care costs associated with obesity in Chinese population in 2011.
abstract: OBJECTIVE
  Overweight and obesity are established major risk factors for type 2 diabetes, and major public health concerns in China. This study aims to assess the economic burden associated with overweight and obesity in the Chinese population ages 45 and older.
  
  
  METHODS
  The Chinese Health and Retirement Longitudinal Study (CHARLS) in 2011 included 13,323 respondents of ages 45 and older living in 450 rural and urban communities across China. Demographic information, height, weight, direct health care costs for outpatient visits, hospitalization, and medications for self-care were extracted from the CHARLS database. Health Care costs were calculated in 2011 Chinese currency. The body mass index (BMI) was used to categorize underweight, normal weight, overweight, and obese populations. Descriptive analyses and a two-part regression model were performed to investigate the association of BMI with health care costs. To account for non-normality of the cost data, we applied a non-parametric bootstrap approach using the percentile method to estimate the 95% confidence intervals (95% CIs).
  
  
  RESULTS
  Overweight and obese groups had significantly higher total direct health care costs (RMB 2246.4, RMB 2050.7, respectively) as compared with the normal-weight group (RMB 1886.0). When controlling for demographic characteristics, overweight and obese adults were 15.0% and 35.9% more likely to incur total health care costs, and obese individuals had 14.2% higher total health care costs compared with the normal-weight group.
  
  
  CONCLUSIONS
  Compared with the normal-weight counterparts, the annual total direct health care costs were significantly higher among obese adults in China.
authors.affiliation: Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China, 410078. Electronic address: jingzhengs@126.com.
authors.forename: Jingcheng
authors.initials: J
authors.lastname: Shi
authors.affiliation: Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA, 70112. Electronic address: ywang38@tulane.edu.
authors.forename: Yao
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China, 410078. Electronic address: 1551632207@qq.com.
authors.forename: Wenwei
authors.initials: W
authors.lastname: Cheng
authors.affiliation: Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA, 70112. Electronic address: raistlinshao@gmail.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Shao
authors.affiliation: Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA, 70112. Electronic address: lshi1@tulane.edu.
authors.forename: Lizheng
authors.initials: L
authors.lastname: Shi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D015992:Body Mass Index; D002681:China / Q000453:epidemiology; D003131:Combined Modality Therapy / Q000191:economics; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures; D019456:Health Transition; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000191:economics / Q000453:epidemiology / Q000208:ethnology / Q000628:therapy*; D050177:Overweight / Q000191:economics / Q000453:epidemiology / Q000208:ethnology / Q000628:therapy*; D015995:Prevalence; D000073278:Self-Management / Q000191:economics; D013851:Thinness / Q000191:economics / Q000453:epidemiology / Q000208:ethnology / Q000628:therapy
keywords: Body mass index; Economic burden; Health care costs; Obesity; Overweight