|Title||The Relationship of Obesity to Hospice Use and Expenditures: A Cohort Study.|
|Publication Type||Journal Article|
|Year of Publication||2017|
|Authors||Harris, TB, Byhoff, E, Perumalswami, CR, Langa, KM, Wright, AA, Griggs, JJ|
|Journal||Annals of Internal Medicine|
|Date Published||2017 Feb 07|
|Keywords||Hospice, Medicare/Medicaid/Health Insurance, Obesity, Older Adults|
Background: Obesity complicates medical, nursing, and informal care in severe illness, but its effect on hospice use and Medicare expenditures is unknown.
Objective: To describe the associations between body mass index (BMI) and hospice use and Medicare expenditures in the last 6 months of life.
Design: Retrospective cohort.
Setting: The HRS (Health and Retirement Study).
Participants: 5677 community-dwelling Medicare fee-for-service beneficiaries who died between 1998 and 2012.
Measurements: Hospice enrollment, days enrolled in hospice, in-home death, and total Medicare expenditures in the 6 months before death. BMI was modeled as a continuous variable with a quadratic functional form.
Results: For decedents with BMI of 20 kg/m2, the predicted probability of hospice enrollment was 38.3% (95% CI, 36.5% to 40.2%), hospice duration was 42.8 days (CI, 42.3 to 43.2 days), probability of in-home death was 61.3% (CI, 59.4% to 63.2%), and total Medicare expenditures were $42 803 (CI, $41 085 to $44 521). When BMI increased to 30 kg/m2, the predicted probability of hospice enrollment decreased by 6.7 percentage points (CI, -9.3 to -4.0 percentage points), hospice duration decreased by 3.8 days (CI, -4.4 to -3.1 days), probability of in-home death decreased by 3.2 percentage points (CI, -6.0 to -0.4 percentage points), and total Medicare expenditures increased by $3471 (CI, $955 to $5988). For morbidly obese decedents (BMI ≥40 kg/m2), the predicted probability of hospice enrollment decreased by 15.2 percentage points (CI, -19.6 to -10.9 percentage points), hospice duration decreased by 4.3 days (CI, -5.7 to -2.9 days), and in-home death decreased by 6.3 percentage points (CI, -11.2 to -1.5 percentage points) versus decedents with BMI of 20 kg/m2.
Limitation: Baseline data were self-reported, and the interval between reported BMI and time of death varied.
Conclusion: Among community-dwelling decedents in the HRS, increasing obesity was associated with reduced hospice use and in-home death and higher Medicare expenditures in the last 6 months of life.
Primary Funding Source: Robert Wood Johnson Foundation Clinical Scholars Program.
|Alternate Journal||Ann. Intern. Med.|