Associations Between Body Mass Index Trajectories and Healthcare Utilization and Costs Among Patients with Type 2 Diabetes in Finland.

IF 4.3 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology Pub Date : 2026-09-23 eCollection Date: 2026-01-01 DOI:10.2147/CLEP.S590966

Zhiting Wang, Piia Lavikainen, Katja Wikström, Janne Martikainen, Tiina Laatikainen

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引用次数: 0

Abstract

Purpose: We assessed how body mass index (BMI) trajectories were associated with healthcare utilization and costs in patients with type 2 diabetes (T2D).

Patients and methods: In this retrospective cohort study, electronic health records from all public healthcare in North Karelia, Finland, were used. Patients newly diagnosed with T2D in 2011-2014 were included. The 10-year BMI trajectories since T2D diagnosis were estimated by growth mixture modeling. Time trends of healthcare utilization and costs from 2012 to 2024, and accumulated healthcare utilization over time within and between BMI trajectories were analyzed using age- and sex-adjusted regression models. Group differences in accumulated healthcare costs with 95% confidence intervals (Cls) were estimated using nonparametric bootstrapping.

Results: Among 3539 patients, 2750 (77.7%) were classified as having stable, 517 (14.6%) increasing, and 272 (7.7%) decreasing BMI trajectories. From 2012 to 2024, mean annual number of specific healthcare utilization and costs increased within BMI trajectories. Compared with the stable BMI trajectory, increasing BMI was associated with 9-55% higher healthcare unitization rates, particularly for all-cause, T2D-related, microvascular, mental health, and inpatient outcomes, over a mean follow-up of 10.8 years (rate ratios ranging from 1.09 to 1.55; 95% CI 1.01-1.86). A similar pattern was observed for accumulated healthcare costs, with mean differences (95% CI) of 6065 € (2741-9795 €) for all causes, 559 € (86 -1174 €) for T2D, 136 € (18-246 €) for microvascular complications, and 312 € (140-509 €) for mental health, and 6477 € (1213-11,889 €) for inpatient stays. However, decreasing BMI was associated with higher accumulated healthcare utilization and costs for macrovascular, mental health, and inpatient outcomes.

Conclusion: Our findings emphasize the importance of monitoring and managing BMI in patients with T2D. However, the observed associations with the decreasing BMI trajectory should be interpreted with caution, as declining BMI may reflect unintentional weight loss.

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芬兰2型糖尿病患者体重指数轨迹与医疗保健利用和费用之间的关系

目的：我们评估了体重指数（BMI）轨迹如何与2型糖尿病（T2D）患者的医疗保健利用和成本相关。患者和方法：在这项回顾性队列研究中，使用了芬兰北卡累利阿所有公共医疗保健机构的电子健康记录。纳入2011-2014年新诊断为T2D的患者。通过生长混合模型估计自T2D诊断以来的10年BMI轨迹。利用年龄和性别调整的回归模型分析了2012 - 2024年医疗保健利用和成本的时间趋势，以及BMI轨迹内和轨迹间的累积医疗保健利用随时间的变化趋势。累积医疗费用的组间差异95%置信区间（Cls）采用非参数自举估计。结果：在3539例患者中，2750例（77.7%）BMI轨迹稳定，517例（14.6%）上升，272例（7.7%）下降。从2012年到2024年，BMI轨迹内特定医疗保健利用和成本的平均年数量增加。与稳定的BMI轨迹相比，在平均10.8年的随访中，BMI增加与9-55%的医疗保健单元率相关，特别是全因、t2d相关、微血管、精神健康和住院结果（比率比从1.09到1.55；95% CI为1.01-1.86）。在累积医疗保健费用方面也观察到类似的模式，所有原因的平均差异（95% CI）为6065欧元（2741-9795欧元），T2D为559欧元（86 -1174欧元），微血管并发症为136欧元（18-246欧元），精神健康为312欧元（140-509欧元），住院费用为6477欧元（1213- 11889欧元）。然而，BMI下降与较高的累积医疗保健利用率和大血管、心理健康和住院结果的成本相关。结论：我们的研究结果强调了监测和管理t2dm患者BMI的重要性。然而，观察到的与BMI下降轨迹的关联应谨慎解释，因为BMI下降可能反映了无意的体重减轻。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Epidemiology Medicine-Epidemiology

CiteScore

6.30

自引率

5.10%

发文量

169

审稿时长

16 weeks

期刊介绍： Clinical Epidemiology is an international, peer reviewed, open access journal. Clinical Epidemiology focuses on the application of epidemiological principles and questions relating to patients and clinical care in terms of prevention, diagnosis, prognosis, and treatment. Clinical Epidemiology welcomes papers covering these topics in form of original research and systematic reviews. Clinical Epidemiology has a special interest in international electronic medical patient records and other routine health care data, especially as applied to safety of medical interventions, clinical utility of diagnostic procedures, understanding short- and long-term clinical course of diseases, clinical epidemiological and biostatistical methods, and systematic reviews. When considering submission of a paper utilizing publicly-available data, authors should ensure that such studies add significantly to the body of knowledge and that they use appropriate validated methods for identifying health outcomes. The journal has launched special series describing existing data sources for clinical epidemiology, international health care systems and validation studies of algorithms based on databases and registries.