Change in overweight and obesity over a decade according to sociodemographic factors in Brazilian adolescents / Mudança no sobrepeso e obesidade após uma década de acordo com fatores sociodemográficos em adolescentes brasileiros

Abstract The aims were to examine changes in the prevalence of overweight and obesity among students from 2001 to 2011, and to verify if these changes differ according to age group, area of residence, and family income. We analyzed two cross-sectional surveys conducted in 2001 and 2011 with brazilian adolescents. Sociodemographic and anthropometric characteristics were self-reported using a questionnaire. Multinomial logistic regression was used to analyze changes in overweight and obesity between the two surveys. The nutritional status was the outcome of the present study and the surveys (2001 and 2011) were the exposure. The odds of being overweight and obese were higher among boys and girls in urban areas in the 2011 survey compared to the 2001. Boys and girls with higher income were also more likely to present overweight and obesity in the second survey compared to the first. An increase of overweight and obesity was observed over a decade. We suggest that future interventions consider the area of residence and the family income to strengthen the effectiveness of actions developed to prevent and control these indicators among adolescents.

Resumo Os objetivos do estudo foram examinar as mudanças na prevalência de sobrepeso e obesidade entre os estudantes de 2001 a 2011 e verificar se essas alterações diferem de acordo com a faixa etária, a área de residência e a renda familiar. Analisamos dois levantamentos transversais realizados em 2001 e 2011 com adolescentes brasileiros. As características sociodemográficas e antropométricas foram autorrelatadas por meio de um questionário. Regressão logística multinomial foi utilizada para analisar as mudanças no sobrepeso e obesidade entre os dois inquéritos. O estado nutricional foi considerado o desfecho do presente estudo e os inquéritos (2001 e 2011) foram as exposições. As razões de chance de sobrepeso e obesidade foram maiores entre os meninos e meninas em áreas urbanas no inquérito de 2011 em comparação com 2001. Meninos e meninas com maior renda também apresentaram maior chance de sobrepeso e obesidade no segundo inquérito. Sugerimos que futuras intervenções considerem a área de residência e a renda familiar para fortalecer a eficácia das ações desenvolvidas para prevenir e controlar esses indicadores entre os adolescentes.

Determinants of outpatient expenditure within primary care in the Brazilian National Health System / Determinantes de gastos ambulatoriais na atenção primária do sistema público de saúde brasileiro

ABSTRACT CONTEXT AND OBJECTIVE: One of the big challenges facing governments worldwide is the financing of healthcare systems. Thus, it is necessary to understand the factors and key components associated with healthcare expenditure. The aim here was to identify demographic, socioeconomic, lifestyle and clinical factors associated with direct healthcare expenditure within primary care, among adults attended through the Brazilian National Health System in the city of Bauru. DESIGN AND SETTING: Cross-sectional study conducted in five primary care units in Bauru (SP), Brazil. METHODS: Healthcare expenditure over the last 12 months was assessed through medical records of adults aged 50 years or more. Annual healthcare expenditure was assessed in terms of medication, laboratory tests, medical consultations and the total. Body mass index, waist circumference, hypertension, age, sex, physical activity and smoking were assessed through face-to-face interviews. RESULTS: The total healthcare expenditure for 963 participants of this survey was US$ 112,849.74 (46.9% consultations, 35.2% medication and 17.9% laboratory tests). Expenditure on medication was associated with overweight (odds ratio, OR = 1.80; 95% confidence interval, CI: 1.07-3.01), hypertension (OR = 3.04; 95% CI: 1.91-4.82) and moderate physical activity (OR = 0.56; 95% CI: 0.38-0.81). Expenditure on consultations was associated with hypertension (OR = 1.67; 95% CI: 1.12-2.47) and female sex (OR = 1.70; 95% CI: 1.14-2.55). CONCLUSIONS: Our results showed that overweight, lower levels of physical activity and hypertension were independent risk factors associated with higher healthcare expenditure within primary care.

RESUMO CONTEXTO E OBJETIVO: Um dos grandes desafios dos governos em todo o mundo é o financiamento de sistemas de saúde e, por isso, é necessário compreender fatores e componentes-chave associados a despesas em saúde. O objetivo foi identificar fatores demográficos, socioeconômicos, de estilo de vida e clínicos associados aos gastos diretos com saúde na atenção primária entre adultos do Sistema Único de Saúde da cidade de Bauru. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado em cinco Unidades Básicas de Saúde em Bauru (SP), Brasil. MÉTODO: Gastos com saúde nos últimos 12 meses foram avaliados através de prontuários médicos de adultos de 50 anos ou mais. Gastos anuais com saúde foram avaliados com: medicamentos, exames laboratoriais, consultas médicas e total. Índice de massa corporal, circunferência da cintura, hipertensão, idade, sexo, atividade física e tabagismo foram avaliados por meio de entrevista face a face. RESULTADOS: O gasto total com serviços de saúde para os 963 participantes deste inquérito foi de US$ 112.849.74 (46,9% consultas, 35,2% medicamentos e 17,9% exames). Gastos com medicamentos foram associados com sobrepeso (odds ratio, OR = 1,80 [intervalo de confiança, IC 95%: 1,07-3,01]), hipertensão (OR = 3,04 [IC 95%: 1,91-4,82]) e atividade física moderada (OR = 0,56 [95% IC: 0,38-0,81]). Gastos com consultas foram associados com hipertensão (OR = 1,67 [IC 95%: 1,12-2,47]) e sexo feminino (OR = 1,70 [IC 95%: 1,14-2,55]). CONCLUSÃO: Nossos resultados mostraram que sobrepeso, menor nível de atividade física e hipertensão são fatores de risco independentes associados com maiores gastos com saúde na atenção primária.

Costs Attributable to Overweight and Obesity in Working Asthma Patients in the United States

PURPOSE: To estimate annual health care and productivity loss costs attributable to overweight or obesity in working asthmatic patients. MATERIALS AND METHODS: This study was conducted using the 2003–2013 Medical Expenditure Panel Survey (MEPS) in the United States. Patients aged 18 to 64 years with asthma were identified via self-reported diagnosis, a Clinical Classification Code of 128, or a ICD-9-CM code of 493.xx. All-cause health care costs were estimated using a generalized linear model with a log function and a gamma distribution. Productivity loss costs were estimated in relation to hourly wages and missed work days, and a two-part model was used to adjust for patients with zero costs. To estimate the costs attributable to overweight or obesity in asthma patients, costs were estimated by the recycled prediction method. RESULTS: Among 11670 working patients with a diagnosis of asthma, 4428 (35.2%) were obese and 3761 (33.0%) were overweight. The health care costs attributable to obesity and overweight in working asthma patients were estimated to be $878 [95% confidence interval (CI): $861–$895] and $257 (95% CI: $251–$262) per person per year, respectively, from 2003 to 2013. The productivity loss costs attributable to obesity and overweight among working asthma patients were $256 (95% CI: $253–$260) and $26 (95% CI: $26–$27) per person per year, respectively. CONCLUSION: Health care and productivity loss costs attributable to overweight and obesity in asthma patients are substantial. This study's results highlight the importance of effective public health and educational initiatives targeted at reducing overweight and obesity among patients with asthma, which may help lower the economic burden of asthma.

Obesidad en Argentina: epidemiología, morbimortalidad e impacto económico / Obesity in Argentina: epidemiology, morbimortality and economic impact

OBJETIVO: obtener conocimientos aplicables al diseño de estrategias de prevención, control y tratamiento de la obesidad y otros factores de riesgo cardiovascular (FRCV), para la toma de decisiones basadas en evidencia local y para optimizar el uso de recursos humanos y económicos en entidades de financiamiento de salud. MÉTODOS: estudio observacional y cuantitativo. Se verificaron: a) asociaciones entre obesidad y características demográficas y epidemiológicas; b) eventos fatales, costo por muerte prematura y Años de Vida Saludables Perdidos atribuibles al sobrepeso/obesidad. RESULTADOS: la prevalencia nacional de sobrepeso y obesidad fue de 34,8% y 14,8%, respectivamente, con edades entre 35 y 64 años. Un tercio de la población obesa presentó obesidad severa a muy severa. El 16,2% de los obesos y el 15,1% de las personas con sobrepeso tenían Necesidades Básicas Insatisfechas. El 40,4% de las personas con obesidad presentaron otros FRCV asociados, siendo la hipertensión arterial el más frecuente (48,1%). Las muertes atribuibles al sobrepeso/obesidad fueron 14.776, con lo cual se perdieron 596.704 Años de Vida Saludables atribuibles al exceso de peso y con un costo total por muerte prematurade AR$ 190,5 millones, del cual el 70% fue atribuible al sobrepeso. CONCLUSIONES: es necesario implementar estrategias efectivas de prevención y tratamiento del sobrepeso/obesidad para disminuir su alto costo económico y los Años de Vida Saludable perdidos por su causa.

OBJECTIVE: To gain knowledge that may be applied to the design of strategies for the prevention, control and treatment of obesity and other cardiovascular risk factors (CVRFs), to promote their use for local evidence-based decision making and to optimize the use of human and economic resources in health financing entities. METHODS: Observational and quantitative study recording: a) associations between obesity and demographic/epidemiological characteristics; b) fatal events, cost of premature deaths and lost healthy life years due to overweight and obesity. RESULTS: National prevalence of overweight and obesity: 34.8% and14.8%, respectively; age range of the adult overweight/obesity population: 35-64 years; one third of the obese population presents severe to very severe obesity; unsatisfied basicneeds: 16.2% and 15.4% in obese and overweight people, respectively; presence of other associated CVRFs: 40.4% of obese people, being hypertension the most frequent one(48.1%); deaths due to overweight//obesity: 14.776; cost of premature deaths: $190.5 millions (70% due to overweight); lost healthy life years due to overweight: 596.704. CONCLUSION: Effective strategies for the prevention and treatment of overweight and obesity should be implemented to decrease the high socioeconomic costs and the lost healthy life years due to the disease.