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Malnutrition Shown Adding Billions to U.S. Health Costs

Apples on a scale

(maxxman, Pixabay)

22 September 2016. An analysis of data from health surveys shows malnutrition associated with 8 common chronic diseases adds $15.5 billion directly to U.S. health care costs. A calculation of these costs, with estimates for each state are published in yesterday’s (21 September) issue of the journal PLoS One.

A team from health care products company Abbott in Abbott Park, Illinois sought to put a reliable price tag on the economic burden of malnutrition, a condition considered treatable and preventable, among people with chronic diseases, as well as note geographic variations of this burden within the U.S. Among the items offered by Abbott are nutritional products for people with chronic diseases, such as diabetes, cancer, and kidney disease.

Earlier studies produced broad estimates of costs related to malnutrition, including additional medical expenses linked directly to malnutrition, as well as indirect costs, extra expenses incurred as a result of the burden placed on others, such as care givers and family members. The authors led by Abbott health economist Scott Goates focused their investigation on direct costs, to provide a more actionable calculation for policy makers, and a common target for state-by-state estimates, as well as breakdowns by age, race, and sex.

Goates and colleagues drew their data from two large-scale national health care surveys, National Health and Nutrition Examination Survey, or Nhanes, and National Health Interview Survey over 6 years. The researchers looked specifically at variables related to nutrition among people with 8 chronic diseases: stroke, chronic obstructive pulmonary disease or COPD, coronary heart failure, breast cancer, dementia, musculoskeletal disorders, depression, and colorectal cancer.

The Abbott team calculates that malnutrition adds $15.5 billion a year in direct expenses each year in health care costs. The highest added health care costs from malnutrition are found among people with dementia, accounting for more than half ($8.7 billion) of the total. Breast cancer generates the fewest additional direct costs due to malnutrition, $76 million.

Older individuals, those 65 and over — the age group most likely to suffer from dementia  — accounted for $4.3 billion of the added direct costs, nearly one-third of the total. Among this group, people with chronic disorders can experience trouble chewing or swallowing. The researchers indicate many patients with these conditions arrive at the hospital with malnutrition, even if obese, or become malnourished at the hospital, which can increase the risk of complications or delay recovery.

As one would expect, states with larger populations like California ($1.7 billion) have the highest additional costs from malnutrition, while smaller states such as Wyoming ($25 million) have the lowest additional costs. On a per capita basis, the District of Columbia pays $65 more per patient as a result of malnutrition, compared to $36 per patient in Utah.

The authors recommend more attention in hospitals to nutritional issues and point to successful pilot programs where better screening and treatment processes contribute to reduced length of stays, fewer readmissions, and lower costs of care for patients. Carol Braunschweig, professor kinesiology and nutrition at University of Illinois in Chicago, and one of the paper’s co-authors, notes in an Abbott statement, “A great deal of research has demonstrated malnutrition negatively impacts health and increases costs to our health care system. By emphasizing the importance of nutrition, from identifying and treating people in the hospital to following up with them once they leave, we can improve people’s health and save money in the process.”

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