Abstract：
OBJECTIVE: Obesity has a significant impact on all-cause mortality rate and overall health care resource use (HCRU). These outcomes are also strongly linked to age, sex and local deprivation of the population. We aimed to establish the lifetime costs of obesity by demographic group/geographic area using published mortality rates and HCRU use for integrated care boards (ICB) in England in the context of costs of therapeutic intervention.
METHODS: Population and expected mortality rates by age, sex and deprivation were obtained from national data. Obesity class prevalence was taken from the health of the nation study. The published impact of obesity by age, group, sex and deprivation on mortality and HCRU were applied to estimate life years lost and lifetime HCRU [by sex, age band and body mass index (BMI) class for each ICB]. The year 2019 was chosen as the study basis data to avoid influences of COVID-19 pandemic on obesity rates with application of 2022/23 HCRU values. Outcomes including prevalence, deaths, life years lost, HCRU and lifetime HCRU were compared by age and sex groups across four BMI classes normal/underweight (BMI <25 kg/m2 ), overweight (25-29.9 kg/m2 ), obese class I and II (30-39.9 kg/m2 ), and obese class III (≥40), with benchmarking being set against all population being BMI <25 kg/m2 overall and by each of the 42 ICBs. We also associated future life with deaths to provide an estimate of \'future life years lost\' occurring each year.
RESULTS: Total population aged >16 years was 45.4 million (51% female).
BACKGROUND: 13.7 million (28% of the total adult population) had a BMI ≥30 mg/m2 and BMI ≥40 kg/m2 were 1.50 million (12%) of these 1.0 million (68%) were female and of these 0.6 million 40% were women aged 16-49 years. In addition, 35% of those with a BMI ≥40 kg/m2 were in the top deprivation quintile (i.e. overall 20%). Mortality was based on expected deaths of 518K/year, and modelling suggested that if a BMI <25 kg/m2 was achieved in all individuals, the death rate would fall by 63K to 455K/year for the English population (12% reduction). For those with a BMI ≥40 kg/m2 the predicted reduction was 12K deaths (54% lower); while in those aged 16-49 years with a BMI ≥40 kg/m2 72% of deaths were linked to obesity. For future life years lost, we estimated 2.5 years were lost in people with BMI 30-39.9 kg/m2 6.7 years when BMI ≥40 kg/m2 . However, for those aged 16-49 years with a BMI ≥40 kg/m2 , 8.3 years were lost. HCRU, for weight reduction, the annual HCRU decrease from BMI ≥40 kg/m2 to BMI 30-39.9 kg/m2 was £342 per person and from BMI 30-39.9 to 25-29.9 kg/m2 the reduction was £316/person. However, lifetime costs were similar because of reduced life expectancy for obese individuals. In quality adjusted life years (QALY), overall, 791 689 future life years were lost (13.1% of all) in people with BMI ≥25 kg/m2 and were related to excess weight. When the NICE £30 000 per QALY value was applied to the estimated total 791 689 future life years lost then the potential QALY value reduction lost was equivalent to £24 billion/year or £522/person in the obese population. For morbidly obese men and women the potential QALY value lost was £2864/person/year. Regarding geography, across the 42 ICBs, we observed significant variation in the prevalence of BMI ≥40 (1.8%-4.3%), excess mortality (11.6%-15.4%) and HCRU linked to higher BMI (7.2%-8.8%). The areas with the greatest impact on HCRU were in the north-west, north-east and Midlands of England, while the south shows less impact.
CONCLUSIONS: The expected increases in annual HCRU because of obesity, when considered over a lifetime, are being mitigated by the increased mortality of obese individuals. Our data suggest that simple short-term HCRU reduction brought about through BMI reduction will be insufficient to fund additional specialist weight reduction interventions. The HRCUs associated with BMI are not in most cases related to short-term health conditions. They are a cumulative result over a number of years, so for age 16-49 years reducing BMI from ≥40 to 30-39.9 kg/m2 might show an annual decrease in HCRU/person by £325/year for women and £80/year for men but this might not have immediately occurred within that year. For those aged >70 years reducing BMI from ≥40 to 30-39.9 kg/m2 might show an annual decrease in HCRU/person by £777/year for women and £796/year for men but also may not be manifest within that year. However, for the morbidly obese men and women, the potential QALY value lost was £2864 per person per year with the potential for these funds to be applied to intensive weight management programmes, including pharmacotherapy.
METHODS: Population and expected mortality rates by age, sex and deprivation were obtained from national data. Obesity class prevalence was taken from the health of the nation study. The published impact of obesity by age, group, sex and deprivation on mortality and HCRU were applied to estimate life years lost and lifetime HCRU [by sex, age band and body mass index (BMI) class for each ICB]. The year 2019 was chosen as the study basis data to avoid influences of COVID-19 pandemic on obesity rates with application of 2022/23 HCRU values. Outcomes including prevalence, deaths, life years lost, HCRU and lifetime HCRU were compared by age and sex groups across four BMI classes normal/underweight (BMI <25 kg/m2 ), overweight (25-29.9 kg/m2 ), obese class I and II (30-39.9 kg/m2 ), and obese class III (≥40), with benchmarking being set against all population being BMI <25 kg/m2 overall and by each of the 42 ICBs. We also associated future life with deaths to provide an estimate of \'future life years lost\' occurring each year.
RESULTS: Total population aged >16 years was 45.4 million (51% female).
BACKGROUND: 13.7 million (28% of the total adult population) had a BMI ≥30 mg/m2 and BMI ≥40 kg/m2 were 1.50 million (12%) of these 1.0 million (68%) were female and of these 0.6 million 40% were women aged 16-49 years. In addition, 35% of those with a BMI ≥40 kg/m2 were in the top deprivation quintile (i.e. overall 20%). Mortality was based on expected deaths of 518K/year, and modelling suggested that if a BMI <25 kg/m2 was achieved in all individuals, the death rate would fall by 63K to 455K/year for the English population (12% reduction). For those with a BMI ≥40 kg/m2 the predicted reduction was 12K deaths (54% lower); while in those aged 16-49 years with a BMI ≥40 kg/m2 72% of deaths were linked to obesity. For future life years lost, we estimated 2.5 years were lost in people with BMI 30-39.9 kg/m2 6.7 years when BMI ≥40 kg/m2 . However, for those aged 16-49 years with a BMI ≥40 kg/m2 , 8.3 years were lost. HCRU, for weight reduction, the annual HCRU decrease from BMI ≥40 kg/m2 to BMI 30-39.9 kg/m2 was £342 per person and from BMI 30-39.9 to 25-29.9 kg/m2 the reduction was £316/person. However, lifetime costs were similar because of reduced life expectancy for obese individuals. In quality adjusted life years (QALY), overall, 791 689 future life years were lost (13.1% of all) in people with BMI ≥25 kg/m2 and were related to excess weight. When the NICE £30 000 per QALY value was applied to the estimated total 791 689 future life years lost then the potential QALY value reduction lost was equivalent to £24 billion/year or £522/person in the obese population. For morbidly obese men and women the potential QALY value lost was £2864/person/year. Regarding geography, across the 42 ICBs, we observed significant variation in the prevalence of BMI ≥40 (1.8%-4.3%), excess mortality (11.6%-15.4%) and HCRU linked to higher BMI (7.2%-8.8%). The areas with the greatest impact on HCRU were in the north-west, north-east and Midlands of England, while the south shows less impact.
CONCLUSIONS: The expected increases in annual HCRU because of obesity, when considered over a lifetime, are being mitigated by the increased mortality of obese individuals. Our data suggest that simple short-term HCRU reduction brought about through BMI reduction will be insufficient to fund additional specialist weight reduction interventions. The HRCUs associated with BMI are not in most cases related to short-term health conditions. They are a cumulative result over a number of years, so for age 16-49 years reducing BMI from ≥40 to 30-39.9 kg/m2 might show an annual decrease in HCRU/person by £325/year for women and £80/year for men but this might not have immediately occurred within that year. For those aged >70 years reducing BMI from ≥40 to 30-39.9 kg/m2 might show an annual decrease in HCRU/person by £777/year for women and £796/year for men but also may not be manifest within that year. However, for the morbidly obese men and women, the potential QALY value lost was £2864 per person per year with the potential for these funds to be applied to intensive weight management programmes, including pharmacotherapy.
摘要：
目的：肥胖对全因死亡率和整体医疗保健资源使用（HCRU）有重大影响。这些结果也与年龄密切相关，性别和当地剥夺人口。我们的目标是在治疗干预成本的背景下，使用已公布的死亡率和英格兰综合护理委员会（ICB）的HCRU使用情况，按人口群体/地理区域确定肥胖的终生成本。
方法：按年龄划分的人口和预期死亡率，性别和剥夺来自国家数据。肥胖类患病率来自国家健康研究。已发表的肥胖对年龄的影响，group,性别和剥夺死亡率和HCRU用于估计寿命年损失和寿命HCRU[按性别，每个ICB的年龄段和体重指数（BMI）等级]。选择2019年作为研究基础数据，以避免COVID-19大流行对肥胖率的影响，应用2022/23HCRU值。结果包括患病率，死亡,失去了生命的岁月，在正常/体重不足（BMI<25kg/m2）的四个BMI类别中，按年龄和性别比较了HCRU和终生HCRU。超重（25-29.9kg/m2），肥胖I级和II级（30-39.9kg/m2），和肥胖III级（≥40），基准是针对所有总体BMI<25kg/m2的人群，并且由42个ICB中的每一个设定。我们还将未来生命与死亡联系起来，以提供每年发生的“未来生命年损失”的估计。
结果：16岁以上的总人口为4540万（51%为女性）。
背景：1370万（占成年总人口的28％）的BMI≥30mg/m2，BMI≥40kg/m2的人中有150万（12％）这100万（68％）是女性，其中60万40％是16-49岁的女性。此外,BMI≥40kg/m2的人中有35％处于最高剥夺位（即总体20％）。死亡率是基于518K/年的预期死亡，建模表明，如果所有个体的BMI<25kg/m2，英国人口的死亡率将下降63K至455K/年（减少12％）。对于BMI≥40kg/m2的人，预计死亡人数减少12K（降低54％）；而在BMI≥40kg/m2的16-49岁人群中，72％的死亡与肥胖有关。为未来的生命失去了岁月，我们估计,当BMI≥40kg/m2时,BMI为30~39.9kg/m2的患者为6.7岁时损失了2.5年.然而,对于BMI≥40kg/m2的16-49岁人群，失去了8.3年。HCCU,为了减轻体重，从BMI≥40kg/m2到BMI30-39.9kg/m2,HCRU每年减少342英镑/人,从BMI30-39.9到25-29.9kg/m2,减少316英镑/人.然而,由于肥胖个体的预期寿命减少,因此终生成本相似.在质量调整生命年(QALY)中，总的来说,BMI≥25kg/m2的人失去了791689个未来生命年（占全部生命的13.1％），并且与超重有关。当NICE每QALY值30,000英镑应用于估计的791689个未来生命年损失时，潜在的QALY值减少损失相当于肥胖人口中的240亿英镑/年或522英镑/人。对于病态肥胖的男性和女性，潜在的QALY价值损失为2864英镑/人/年。关于地理,在42个ICB中，我们观察到BMI≥40（1.8%-4.3%）的患病率存在显著差异，超额死亡率(11.6%-15.4%)和HCRU与较高BMI(7.2%-8.8%)相关.对HCCU影响最大的地区是西北部，英格兰东北部和中部地区,而南方的影响较小。
结论：由于肥胖，每年HCLU的预期增加，当考虑到一生时，正在缓解肥胖个体死亡率的增加。我们的数据表明，通过降低BMI带来的简单短期HCRU降低不足以资助额外的专业减肥干预措施。与BMI相关的HRCU在大多数情况下与短期健康状况无关。它们是多年来累积的结果，因此,对于16-49岁的患者,将BMI从≥40降低至30-39.9kg/m2,女性HCRU/人每年降低325英镑/年,男性每年降低80英镑/年,但这可能不会在当年内立即发生.对于年龄>70岁的人，将BMI从≥40降低到30-39.9kg/m2可能显示HCRU/人每年减少777英镑/年，男性每年减少796英镑/年，但也可能不会在那一年内表现出来。然而,对于病态肥胖的男人和女人来说，潜在的QALY价值损失为每人每年2864英镑，这些资金有可能用于强化体重管理计划，包括药物治疗.
方法：按年龄划分的人口和预期死亡率，性别和剥夺来自国家数据。肥胖类患病率来自国家健康研究。已发表的肥胖对年龄的影响，group,性别和剥夺死亡率和HCRU用于估计寿命年损失和寿命HCRU[按性别，每个ICB的年龄段和体重指数（BMI）等级]。选择2019年作为研究基础数据，以避免COVID-19大流行对肥胖率的影响，应用2022/23HCRU值。结果包括患病率，死亡,失去了生命的岁月，在正常/体重不足（BMI<25kg/m2）的四个BMI类别中，按年龄和性别比较了HCRU和终生HCRU。超重（25-29.9kg/m2），肥胖I级和II级（30-39.9kg/m2），和肥胖III级（≥40），基准是针对所有总体BMI<25kg/m2的人群，并且由42个ICB中的每一个设定。我们还将未来生命与死亡联系起来，以提供每年发生的“未来生命年损失”的估计。
结果：16岁以上的总人口为4540万（51%为女性）。
背景：1370万（占成年总人口的28％）的BMI≥30mg/m2，BMI≥40kg/m2的人中有150万（12％）这100万（68％）是女性，其中60万40％是16-49岁的女性。此外,BMI≥40kg/m2的人中有35％处于最高剥夺位（即总体20％）。死亡率是基于518K/年的预期死亡，建模表明，如果所有个体的BMI<25kg/m2，英国人口的死亡率将下降63K至455K/年（减少12％）。对于BMI≥40kg/m2的人，预计死亡人数减少12K（降低54％）；而在BMI≥40kg/m2的16-49岁人群中，72％的死亡与肥胖有关。为未来的生命失去了岁月，我们估计,当BMI≥40kg/m2时,BMI为30~39.9kg/m2的患者为6.7岁时损失了2.5年.然而,对于BMI≥40kg/m2的16-49岁人群，失去了8.3年。HCCU,为了减轻体重，从BMI≥40kg/m2到BMI30-39.9kg/m2,HCRU每年减少342英镑/人,从BMI30-39.9到25-29.9kg/m2,减少316英镑/人.然而,由于肥胖个体的预期寿命减少,因此终生成本相似.在质量调整生命年(QALY)中，总的来说,BMI≥25kg/m2的人失去了791689个未来生命年（占全部生命的13.1％），并且与超重有关。当NICE每QALY值30,000英镑应用于估计的791689个未来生命年损失时，潜在的QALY值减少损失相当于肥胖人口中的240亿英镑/年或522英镑/人。对于病态肥胖的男性和女性，潜在的QALY价值损失为2864英镑/人/年。关于地理,在42个ICB中，我们观察到BMI≥40（1.8%-4.3%）的患病率存在显著差异，超额死亡率(11.6%-15.4%)和HCRU与较高BMI(7.2%-8.8%)相关.对HCCU影响最大的地区是西北部，英格兰东北部和中部地区,而南方的影响较小。
结论：由于肥胖，每年HCLU的预期增加，当考虑到一生时，正在缓解肥胖个体死亡率的增加。我们的数据表明，通过降低BMI带来的简单短期HCRU降低不足以资助额外的专业减肥干预措施。与BMI相关的HRCU在大多数情况下与短期健康状况无关。它们是多年来累积的结果，因此,对于16-49岁的患者,将BMI从≥40降低至30-39.9kg/m2,女性HCRU/人每年降低325英镑/年,男性每年降低80英镑/年,但这可能不会在当年内立即发生.对于年龄>70岁的人，将BMI从≥40降低到30-39.9kg/m2可能显示HCRU/人每年减少777英镑/年，男性每年减少796英镑/年，但也可能不会在那一年内表现出来。然而,对于病态肥胖的男人和女人来说，潜在的QALY价值损失为每人每年2864英镑，这些资金有可能用于强化体重管理计划，包括药物治疗.
