| Summary: | 碩士 === 國防醫學院 === 公共衛生學研究所 === 106 === The elderly population and its prevalence of obesity have increased year by year. Various aspects of obesity may be assessed by anthropometry. With age body composition changes, body fat increases, and lean body mass, especially skeletal muscle mass decreases. Elderly with sarcopenic obesity, are more likely to be frail. A longitudinal study based on the 1999-2000 National Nutrition and Health Survey in Taiwan for adults 65 years of age or older has been linked to the National Health Insurance database until 2006 and the National Death Registration database until 2008. Obesity and skeletal muscle mass indices have been considered in relation to medical service utilization and mortality in this population.
Generalized linear models with appropriate adjustments were used to assess differences in utilization and costs of medical service for elderly according to body composition. BMI or waist circumference and skeletal muscle mass index (SMMI) were combined (Q1= low SMMI group; Q2-Q4= high SMMI group), to explore the effect of obesity and low SMMI on medical service utilization and expenditure. The Cox proportional-hazards model was used to estimate the relative risk of mortality after adjusting for covariates.
Regardless of index, obese elderly used more outpatient services (including chronic diseases) and incurred greater expenditure, and those who were underweight had longer hospitalization(days), used emergency services more often, and had greater total medical expenditure. Compared with the normal BMI-high SMMI group, the obese-low SMMI group had 29% (exp(β) = 1.29, 95% CI: 1.15-1.44) more expenditure on chronic disease. Compared with the non-abdominally obese and high SMMI group, the abdominally obese-low SMMI had 11% more outpatient services (exp(β) = 1.11, 95% CI: 1.06-1.16), 10% more chronic disease services (exp(β) = 1.10, 95% CI: 1.03-1.17) and a 67% increase in risk of death (HR = 1.67, 95% CI: 1.13-2.44). The underweight-low SMMI group had 84% more emergency attendances (exp(β) = 1.84, 95% CI: 1.41-2.39) and 96% more emergency expenditures (exp(β) = 1.96, 95%CI: 1.12-3.46) as well as double the hospitalization (exp(β) = 2.25, 95% CI: 2.10-2.42) and the total medical expenditure (exp(β) = 2.13, 95% CI: 1.58-2.87) along with triple the hospitalization expenditure (exp(β) = 3.18, 95% CI: 1.63-6.21) and the risk of death (HR: 2.73, 95% CI: 1.84-4.04). Taking BMI and waist circumference into account, the normal BMI-abdominally obese-low SMMI group had an increased the risk of death of 1.3 times (HR = 2.32, 95% CI: 1.48-3.81).
In conclusion, either obesity or underweight, in combination with low SMMI increase the risk of medical utilization and mortality in the elderly.
Keywords: Medical utilization, Mortality, Older adults, Obesity indices, Sarcopenic
obesity
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