Cost of care of chronic non-communicable diseases in Jamaican patients: the role of obesity

Christine M. Fray-Aiken, Rainford J. Wilks, Abdullahi O. Abdulkadri, Affette M. McCaw-Binns

DOI: https://doi.org/10.7175/fe.v17i2.1232

Abstract

OBJECTIVE: To estimate the economic cost of Chronic Non-Communicable Diseases (CNCDs) and the portion attributable to obesity among patients in Jamaica.

METHODS: The cost-of-illness approach was used to estimate the cost of care in a hospital setting in Jamaica for type 2 diabetes mellitus, hypertension, coronary heart disease, stroke, gallbladder disease, breast cancer, colon cancer, osteoarthritis, and high cholesterol. Cost and service utilization data were collected from the hospital records of all patients with these diseases who visited the University Hospital of the West Indies (UHWI) during 2006. Patients were included in the study if they were between15 and 74 years of age and if female, were not pregnant during that year. Costs were categorized as direct or indirect. Direct costs included costs for prescription drugs, consultation visits (emergency and clinic visits), hospitalizations, allied health services, diagnostic and treatment procedures. Indirect costs included costs attributed to premature mortality, disability (permanent and temporary), and absenteeism. Indirect costs were discounted at 3% rate.

RESULTS: The sample consisted of 554 patients (40%) males (60%) females. The economic burden of the nine diseases was estimated at US$ 5,672,618 (males 37%; females 63%) and the portion attributable to obesity amounted to US$ 1,157,173 (males 23%; females 77%). Total direct cost was estimated at US$ 3,740,377 with female patients accounting for 69.9% of this cost. Total indirect cost was estimated at US$ 1,932,241 with female patients accounting for 50.6% of this cost. The greater cost among women was not found to be statistically significant. Overall, on a per capita basis, males and females accrued similar costs-of-illness (US$ 9,451.75 vs. US$ 10,758.18).

CONCLUSIONS: In a country with per capita GDP of less than US$ 5,300, a per capita annual cost of illness of US$ 10,239 for CNCDs is excessive and has detrimental implications for the health and development of Jamaica.

Keywords

Chronic non-communicable diseases; Obesity; Cost-of-illness

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References

  • Omran AR. The epidemiologic transition. A theory of the epidemiology of population change. Milbank Mem Fund Q 1971; 49: 509-8; http://dx.doi.org/10.2307/3349375
  • World Health Organization. Global Health Risks: Mortality and burden of disease attributable to selected major risks. Geneva: WHO Press, 2009
  • Yusuf S, Reddy S, Ôunpuu S, et al. Global Burden of Cardiovascular Diseaes: Part I: General Considerations, the Epidemiologic Transition, Risk Factors, and Impact of Urbanization. Circulation 2001; 104: 2746-53; http://dx.doi.org/10.1161/hc4601.099487
  • World Health Organization Global InfoBase team. The SuRF Report 2. Surveillance of chronic risk factors: Country-level data and comparable estimates. Geneva: WHO Press, 2005
  • Wilks R, Younger N, Tulloch-Reid M, et al. Jamaica Health and Lifestyle Survey 2007-8. TECHNICAL REPORT. Epidemiology Research Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, 2008
  • Guh DP, Zhang W, Bansback N, et al. The Incidence of Co-morbidities Related to Obesity and Overweight: A systematic review and meta-analysis. BMC Public Health 2009; 9; http://dx.doi.org/10.1186/1471-2458-9-88
  • World Health Organization. Obesity and Overweight factsheet from the WHO. Available at: http://www.who.int/mediacentre/factsheets/fs311/en (last accessed May 2016)
  • Bray G. Medical Consequencies of Obesity. J Clin Endocrinol Metab 2004; 89: 2583-9; http://dx.doi.org/10.1210/jc.2004-0535
  • Field A, Coakley E, Must A, et al. Impact of Overweight on the Risk of Developing Common Chronic Diseases During a 10-Year Period. Arch Intern Med 2001; 161: 1581-6; http://dx.doi.org/10.1001/archinte.161.13.1581
  • Must A, Spadano J, Coakley EH, et al. The Disease Burden Associated with Overweight and Obesity. JAMA 1999; 282: 1523-9; http://dx.doi.org/10.1001/jama.282.16.1523
  • Colditz G, Willet W, Ronitzky A, et al. Weight Gain as a Risk Factor for Clinical Diabetes Mellitus in Women. Ann Intern Med 1995; 122: 481-6; http://dx.doi.org/10.7326/0003-4819-122-7-199504010-00001
  • Caribbean Commission on Health and Development. Report of the Caribbean Commission on Health and Development. Ian Randle Publishers, 2006
  • Sasai H, Sairenchi T, Iso H, et al. Relationship between Obesity and Incident Diabetes in Middle-aged and Older Japanese Adults: The Ibaraki Prefectural Health Study. Mayo Clin Proc 2010; 85: 36-40; http://dx.doi.org/10.4065/mcp.2009.0230
  • Cassano P, Rosner B, Vokonas P, et al. Obesity and Body Fat Distribution in Relation to the Incidence of Non-insulin-dependent Diabetes Mellitus. A prospective Cohort Study of Men in the Normative Aging Study. Am J Epidemiol 1992; 136: 1474-86
  • Tulloch-Reid MK, Hanson RL, Williams DE, et al. Do Measures of Body Fat Distribution Provide Information on the Risk of Type 2 Diabetes in Addition to Measures of General Obesity? Diabetes Care 2003; 26: 2556-61; http://dx.doi.org/10.2337/diacare.26.9.2556
  • Vazquez G, Duval S, Jacobs Jr. DR, et al. Comparison of Body Mass Index, Waist Circumference, and Waist/Hip Ratio in Predicting Incident Diabetes: A meta-analysis. Epidemiol Rev 2007; 29 : 115-28; http://dx.doi.org/10.1093/epirev/mxm008
  • Stampfer MJ, Maclure KM, Colditz GA, et al. Risk of syptomatic gallstones in women with severe obesity. Am J Clin Nut 1992; 55: 652-8
  • Tsai CJ, Leitzmann MF, Willett WC, et al. Prospective study of abdominal adiposity and gallstone disease in US men. Am J Clin Nut 2004; 80: 38-44
  • Okosun IS, Cooper RS, Rotimi CN, et al. Association of Waist Circumference with Risk of Hypertension and Type 2 Diabetes in Nigerians, Jamaicans, and African Americans. Diabetes Care 1998; 21: 1836-42; http://dx.doi.org/10.2337/diacare.21.11.1836
  • Girotto E, de Andrade SM, Cabrera MA. Prevalence of Abdominal Obesity in Hypertensive Patients Registered in a Family Health Unit. Arq Bras Cardio 2010; 94: 754-62; http://dx.doi.org/10.1590/S0066-782X2010005000049
  • Wamala JF, Karyabakabo Z, Ndungutse D, et al. Prevalence factors associated with Hypertension in Rukungiri District, Uganda - A Community-based Study. Afr Health Sci 2009; 9: 153-60
  • de Koning L, Merchant A, Pogue JA. Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J 2007; 28: 850-6; http://dx.doi.org/10.1093/eurheartj/ehm026
  • Rexrode KM, Carey VJ, Hennekens CH, et al. Abdominal Adiposity and Coronary Heart Disease in Women. JAMA 1998; 280: 1843-8; http://dx.doi.org/10.1001/jama.280.21.1843
  • Rexrode KM, Buring JE, Manson JE. Abdominal and total adiposity and risk of coronary heart disease in men. Int J Obese 2001; 25: 1047-56; http://dx.doi.org/10.1038/sj.ijo.0801615
  • Gelber RP, Gaziano JM, Orav EJ, et al. Measures of Obesity and Cardiovascular Risk among Men and Women. J Am Coll Cardio 2008; 52: 605-15; http://dx.doi.org/10.1016/j.jacc.2008.03.066
  • Owen CG, Whincup PH, Orfei L, et al. Is body mass index before middle age related to coronary heart disease risk in later life? Evidence from observational studies. Int J Obese 2009; 33: 866-77; http://dx.doi.org/10.1038/ijo.2009.102
  • Hubert HB, Feinleib M, McNamara PM, et al. Obesity as an independent risk factor for cardiovascular disease: A 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983; 67: 968-77; http://dx.doi.org/10.1161/01.CIR.67.5.968
  • Zhang X, Shu X-O, Gao Y-T, et al. General and Abdominal Adiposity and Risk of Stroke in Chinese Women. Stroke 2009; 40: 1098-104; http://dx.doi.org/10.1161/STROKEAHA.108.539692
  • Walker SP, Rimm EB, Ascherio A, et al. Body size and fat distribution as predictors of stroke among US men. Am J Epidemiol 1996; 144: 1143-50; http://dx.doi.org/10.1093/oxfordjournals.aje.a008892
  • Suk S-H, Sacco RL, Boden-Albala B, et al. Abdominal Obesity and Risk of Ischemic Stroke: The Nothern Manhattan Stroke Study. Stroke 2003; 34: 1586-92; http://dx.doi.org/10.1161/01.STR.0000075294.98582.2F
  • Kurth T, Gaziano JM, Berger K, et al. Body Mass Index and the Risk of Stroke in Men. Arch Intern Med 2002; 162: 2557-62; http://dx.doi.org/10.1001/archinte.162.22.2557
  • Kurth T, Gaziano JM, Rexrode KM, et al. Prospective Study of Body Mass Index and Risk of Stroke in Apparently Health Women. Circulation 2005; 111: 1992-8; http://dx.doi.org/10.1161/01.CIR.0000161822.83163.B6
  • Hu D, Hannah J, Gray RS, et al. Effects of Obesity and Body Fat Distribution on Lipids and Lipoproteins in Nondiabetic American Indians: The Strong Heart Study. Obes Res 2000; 8: 411-21; http://dx.doi.org/10.1038/oby.2000.51
  • Gostynski M, Gutzwiller F, Kuulasmaa K, et al. Analysis of the relationship between total cholesterol, age, body mass index among males and females in the WHO MONICA Project. Int J Obese 2004; 28: 1082-90; http://dx.doi.org/10.1038/sj.ijo.0802714
  • Steyn K, Sliwa K, Hawken S, et al. Risk Factors Associated with Myocardial
  • Infarction in Africa: The INTERHEART Africa Study. Circulation 2005; 3554-61
  • McCaw-Binns A, Holder Y, Spence K, et al. Multisource method for determining mortality in Jamaica: 1996 and 1998. Department of Community Health & Psychiatry, University of the West Indies. International Biostatistics Information Services. Division of Health Promotion & Protection, Ministry of Health, Jamaica. Statistical Institute of Jamaica. 2002
  • Abdulkadri AO, Cunningham-Myrie C, Forrester T. Economic Burden of Diabetes and Hypertension in CARICOM States. Social and Economic Studies 2009; 58: 175-97
  • Colditz GA. Economic Costs of Obesity. Am J Clin Nut 1992; 55: 503S-7S
  • Wolf AM, Colditz GA. Current Estimates of the Economic Cost of Obesity in the United States. Obes Res 1998; 6: 97-106
  • Finkelstein EA, Fiebelkorn IC, Wang G. National Medical Spending Attributable to Overweight and Obesity: How Much and Who’s Paying? Health Aff 2003; 219-26
  • Wilson PW, D’Agostino RB, Sullivan L, et al. Overweight and Obesity as Determinants of Cardiovascular Risk. The Framingham Experience. Arch Intern Med 2002; 162: 1867-72; http://dx.doi.org/10.1001/archinte.162.16.1867
  • Statistical Institute of Jamaica. End of Year Population by Age and Sex: 2009, 2009. Available at: http://www.statinja.gov.jm/EndofYearPopulationbyAgeandSex2008.aspx
  • Barcelo´ A, Aedo C, Rajpathak S, et al. The Cost of Diabetes in Latin America and the Caribbean. Bull World Health Organ 2003; 81: 19-27
  • Prüss-Üstün A, Mathers C, Corvalán C, et al. Introduction and methods: assessing the environmental burden of disease at national and local levels. Geneva: World Health Organization, 2003
  • PAHO. Techniques to Measure the Impact of Mortality: Years of Potential Life Lost. Epidemiol Bull 2003; 24: 1-16
  • The Tripartite Meeting of Experts on Labour Statistics. Updating the International Standard Classification of Occupations (ISCO-88). Geneva, 2007
  • Jamaica Employers’ Federation. Salary and Benefits Survey for Cheif Executive Officers, Executives and Managers. Kingston: Jamaica Employers’ Federation (JEF), 2009
  • Jamaica Employers’ Federation. Salary and Benefits Survey for Technical and Professional Staff, Supervisory, Clerical, and Hourly-rated Employees. Kingston: Jamaica Employers’ Federation (JEF), 2009
  • Mattke S, Balakrishnan A, Bergamo G, et al. A Review of Methods to Measure Health-related Productivity Loss. Am J Manag Care 2007; 13: 211-17
  • Flor LS, Campos MR, de Oliveira AF, et al. Diabetes burden in Brazil: fraction attributable to overweight, obesity, and excess weight. Rev Saúde Publican 2015; 49: 1-10; http://dx.doi.org/10.1590/S0034-8910.2015049005571
  • Birmingham CL, Muller JL., Palepu A, et al. The Cost of Obesity in Canada. CMAJ 1999; 160: 483-8
  • de Oliveira ML, Santos LMP, da Silva EN. Direct Healthcare Cost of Obesity in Brazil: An Application of the Cost-of-Illness Method from the Perspective of the Public Health System in 2011 PLoS ONE 2015; 10: e0121160; http://dx.doi.org/10.1371/journal.pone.0121160
  • Arnold M, Pandeya N, Byrnes G, et al. Global burden of cancer attributable to high body-mass index in 2012: a population-based study. Lancet Oncol 2015; 16: 36-46; http://dx.doi.org/10.1016/S1470-2045(14)71123-4
  • Cooper BS, Rice DP. The economic cost of illness revisited. Soc Secur Bull 1976; 39: 21-36
  • Zakrzewska K. Presenteeism - Unhealthy Extra Presence in the Workplace. Przegl Epidemiol 2014; 68: 77-80
  • Fowke JH, Motley SS, Concepcion RS, et al. Obesity, body composition, and prostate cancer. BMC Cancer 2012; 12: 23; http://dx.doi.org/10.1186/1471-2407-12-23
  • Oster G, Edelsberg J, O’Sullivan AK, et al. The Clinical and Economic Burden of Obesity in a Managed Care Setting. Am J Manag Care 2000; 6: 681-9
  • Levenson JW, Skerrett PJ, Gaziano JM. Reducing the global burden of cardiovascular disease: The role of risk factors. Prev Cardio 2002; 5: 188-99; http://dx.doi.org/10.1111/j.1520-037X.2002.00564.x
  • Leeder S, Raymond S, Greenberg H, et al. A Race Against Time: The Challenge of Cardiovascular Disease in Developing Economies. New York: The Center for Global Heath and Economic Development, 2004
  • Cruz A, ed. Health in the Americas, 2007. Washington, D.C.: Pan American Health Organization, 2007, pp. 448-64

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