title: Impact and attribute of each obesity-related cardiovascular risk factor in combination with abdominal obesity on total health expenditures in adult Japanese National Health insurance beneficiaries: The Ibaraki Prefectural health study.
abstract: BACKGROUND
  The aim of this study was to examine the attribution of each cardiovascular risk factor in combination with abdominal obesity (AO) on Japanese health expenditures.
  
  
  METHODS
  The health insurance claims of 43,469 National Health Insurance beneficiaries aged 40-75 years in Ibaraki, Japan, from the second cohort of the Ibaraki Prefectural Health Study were followed-up from 2009 through 2013. Multivariable health expenditure ratios (HERs) of diabetes mellitus (DM), high low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C), and hypertension with and without AO were calculated with reference to no risk factors using a Tweedie regression model.
  
  
  RESULTS
  Without AO, HERs were 1.58 for DM, 1.06 for high LDL-C, 1.27 for low HDL-C, and 1.31 for hypertension (all P < 0.05). With AO, HERs were 1.15 for AO, 1.42 for DM, 1.03 for high LDL-C, 1.11 for low HDL-C, and 1.26 for hypertension (all P < 0.05, except high LDL-C). Without AO, population attributable fractions (PAFs) were 2.8% for DM, 0.8% for high LDL-C, 0.7% for low HDL-C, and 6.5% for hypertension. With AO, PAFs were 1.0% for AO, 2.3% for DM, 0.4% for low HDL-C, and 5.0% for hypertension.
  
  
  CONCLUSIONS
  Of the obesity-related cardiovascular risk factors, hypertension, independent of AO, appears to impose the greatest burden on Japanese health expenditures.
authors.affiliation: Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsugagun-Mibu, Japan; Ibaraki Health Plaza, Mito, Japan; Ibaraki Health Service Association, Mito, Japan. Electronic address: tossair@dokkyomed.ac.jp.
authors.forename: Toshimi
authors.initials: T
authors.lastname: Sairenchi
authors.affiliation: Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iso
authors.affiliation: Ibaraki Health Plaza, Mito, Japan; Ibaraki Health Service Association, Mito, Japan; Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Yamagishi
authors.affiliation: Department of Health and Welfare, Ibaraki Prefectural Office, Mito, Japan.
authors.forename: Fujiko
authors.initials: F
authors.lastname: Irie
authors.affiliation: Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsugagun-Mibu, Japan; Ibaraki Health Plaza, Mito, Japan; Ibaraki Health Service Association, Mito, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Nagao
authors.affiliation: Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsugagun-Mibu, Japan; Ibaraki Health Plaza, Mito, Japan; Ibaraki Health Service Association, Mito, Japan.
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Umesawa
authors.affiliation: Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsugagun-Mibu, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Haruyama
authors.affiliation: Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsugagun-Mibu, Japan.
authors.forename: Gen
authors.initials: G
authors.lastname: Kobashi
authors.affiliation: Ibaraki Health Service Association, Mito, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Watanabe
authors.affiliation: Ibaraki Health Plaza, Mito, Japan; Ibaraki Health Service Association, Mito, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ota
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics* / Q000453:epidemiology; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D056128:Obesity, Abdominal / Q000191:economics* / Q000453:epidemiology; D012307:Risk Factors
keywords: Abdominal obesity; Cardiovascular disease; Cohort study; Health expenditure; Risk factor