| Literature DB >> 35906047 |
Shingo Fukuma1, Mitsuru Mukaigawara2, Toshiaki Iizuka3, Yusuke Tsugawa4,5.
Abstract
OBJECTIVES: Increases in obesity and cardiovascular diseases contribute to rapidly growing healthcare expenditures in many countries. However, little is known about whether the population-level health guidance intervention for obesity and cardiovascular risk factors is associated with reduced healthcare utilisation and spending. The aim of this study was to investigate the effect of population-level health guidance intervention introduced nationally in Japan on healthcare utilisation and spending.Entities:
Keywords: health economics; internal medicine; preventive medicine; public health
Mesh:
Year: 2022 PMID: 35906047 PMCID: PMC9345054 DOI: 10.1136/bmjopen-2021-056996
Source DB: PubMed Journal: BMJ Open ISSN: 2044-6055 Impact factor: 3.006
Characteristics of participants in the national health screening programme
| Characteristics | Total | Within bandwidth of 6 cm |
| Age, years | 49.4 (44.4–57.4) | 50.0 (44.8–58.4) |
| Female, n (%) | 30 263 (26.7%) | 6111 (11.9%) |
| Waist circumference, cm | 83.5 (77.3–90) | 85.1 (82.5–88) |
| Above the cut-off, n (%) | 46 701 (41.2%) | 24 214 (47.3%) |
| Body mass index* | 23.5 (21.3–25.8) | 24 (22.8–25.3) |
| Systolic blood pressure (SBP), mm Hg | 124 (113–134) | 125 (115–135) |
| Diastolic blood pressure (DBP), mm Hg | 77 (69–85) | 78 (71–86) |
| Triglyceride, mg/dL | 98 (68–149) | 109 (78–159) |
| High-density lipoprotein (HDL) cholesterol, mg/dL | 60 (50–72) | 57 (49–67) |
| Haemoglobin A1c (HbA1c), % | 5.5 (5.3–5.7) | 5.5 (5.3–5.7) |
| Fasting blood glucose (FBG), mg/dL | 94 (87–102) | 95 (88–103) |
| Current smoking, n (%) | 34 186 (30.2%) | 17 233 (33.7%) |
| Antihypertensive drug, n (%) | 18 414 (16.3%) | 8860 (17.3%) |
| Antidiabetic drug, n (%) | 5241 (4.6%) | 2325 (4.5%) |
| Antihyperlipidemic drug, n (%) | 10 556 (9.3%) | 4987 (9.7%) |
| SBP≥130 mm Hg, DBP≥85 mm Hg or antihypertensive drug | 50 963 (45.0%) | 24 934 (48.7%) |
| FBG≥100 mg/dL, HbA1c≥5.6% or antidiabetic drug | 52 559 (46.4%) | 24 651 (48.1%) |
| Triglyceride≥150 mg/dL, HDL cholesterol<40 mg/dL or antihyperlipidemic drug | 36 613 (32.3%) | 18 842 (36.8%) |
*Calculated as weight in kilograms divided by height in metres squared.
Figure 1Healthcare utilisation and spending for 3 years according to assignment to health guidance intervention: regression discontinuity plots. The dots and error bars indicate sample means and 95% CIs, respectively. The vertical solid line indicates the cut-off of waist circumference, which is an assignment variable for health guidance intervention.
Association of assignment to the national health guidance intervention with healthcare utilisation and healthcare spending (3 years cumulative) using fuzzy regression discontinuity design* (ITT effect)
| Bandwidth,† cm (number) | Average within bandwidth | Adjusted effects | 95% CI | P value | |
| Healthcare utilisation | |||||
| 6.1 (44 333) | 26.4 days | −1.3 days | (−11.4 to −0.5) | 0.03 | |
| 6.8 (47 016) | 30.0 % | −3.8 pp | (−9.0 to +1.4) | 0.15 | |
| 6.9 (47 726) | 14.4 % | −1.2 pp | (−7.2 to +4.1) | 0.59 | |
| Healthcare spending | |||||
| 5.9 (42 050) | US$3816 | −US$1138 | (−4506 to +932) | 0.20 | |
| 5.7 (41 081) | US$2366 | +US$46 | (−2063 to +1572) | 0.79 | |
| 6.3 (44 986) | US$1450 | −US$1214 | (−2932 to +68) | 0.06 | |
*We used the data-driven approach to determine the optimal bandwidths for each outcome variables we have investigated.
†We selected optimal bandwidths for each outcome by data-driven approach.
‡We adjusted for age, gender, current smoking and baseline medication use.
§Any medication includes drugs for hypertension, hyperglycaemic and hyperlipidemia.
Association of receipt of the national health guidance intervention with healthcare utilisation and healthcare spending (3 years cumulative) using fuzzy regression discontinuity design* (treatment-to-treat effect)
| Bandwidth,† cm | Adjusted effects | 95% CI | P value | |
| Healthcare utilisation | ||||
| 8.2 (55 458) | −10.6 days | (−42.7 to +18.7) | 0.45 | |
| 8.8 (57 815) | −28.0 pp | (−56.7 to +6.5) | 0.12 | |
| 9.1 (60 250) | −14.7 pp | (−38.2 to +25.8) | 0.70 | |
| Healthcare spending | ||||
| 7.2 (50 273) | −US$7638 | (−23 672 to +7351) | 0.30 | |
| 7.3 (50 940) | −US$4 | (−9549 to +11 022) | 0.89 | |
| 6.7 (46 974) | −US$7818 | (−18 900 to +368) | 0.06 | |
*We used the data-driven approach to determine the optimal bandwidths for each outcome variables we have investigated.
†We selected optimal bandwidths for each outcome by data-driven approach.
‡We adjusted for age, gender, current smoking, and baseline medication use.
§Any medication includes drugs for hypertension, hyperglycaemic and hyperlipidemia.