{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T22:51:53Z","timestamp":1759963913360,"version":"3.41.2"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T00:00:00Z","timestamp":1713916800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Obesity has been extensively studied over the years, primarily focusing on the physiological aspects of the disease. However, the general burden of obesity mainly the financial implications and its influence on hospitalization and length of stay have only recently garnered attention in the literature, particularly in the case of Portugal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>This study aimed to investigate the association between obesity and hospitalizations in the Portuguese adult population and compare the average costs of hospitalization among participants with and without obesity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>At baseline, the analytic sample consisted of 10,102 participants aged \u226518\u2009years from the Portuguese population-based Epidemiology of Chronic Diseases Cohort (EpiDoC). Participants were then followed for up to 10\u2009years from 2011 to 2021 in three more waves of data collection. Body mass index was derived from self-reported weight and height, and instances of hospitalization were self-reported by the participants. The associated costs for each hospitalization episode were categorized according to national legislation and valued according to the pricing for Diagnosis Related Groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Obesity was associated with more hospitalizations (for example, Obesity class I vs. normal weight: OR\u2009=\u20091.33 [1.14\u20131.55]). However, when the presence of multimorbidity was considered, this association diminished. While longer hospital length of stay was observed in individuals with higher obesity categories, this difference did not reach statistical significance. On average, the total hospitalization costs per patient with obesity amounted to \u20ac200.4 per year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Obesity is as a risk factor for hospitalizations and potentially with higher length of stay hospitalizations, with this effect being partially mediated by the concurrent presence of multimorbidity. Consequently, obesity constitutes an additional burden on healthcare systems. This underscores the imperative of implementing cost-effective prevention programs aimed at addressing and managing this significant public health concern.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1380690","type":"journal-article","created":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T04:22:03Z","timestamp":1713932523000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Hospitalization costs in Portugal among people with obesity: results from a nationwide population-based cohort 2011 to 2021"],"prefix":"10.3389","volume":"12","author":[{"given":"Kelli","family":"Destri","sequence":"first","affiliation":[]},{"given":"Ana Rita","family":"Henriques","sequence":"additional","affiliation":[]},{"given":"Nuno","family":"Mendon\u00e7a","sequence":"additional","affiliation":[]},{"given":"Joana","family":"Alves","sequence":"additional","affiliation":[]},{"given":"Anabela","family":"Barcelos","sequence":"additional","affiliation":[]},{"given":"Sara Sim\u00f5es","family":"Dias","sequence":"additional","affiliation":[]},{"given":"Maria Jo\u00e3o","family":"Greg\u00f3rio","sequence":"additional","affiliation":[]},{"given":"Helena","family":"Canh\u00e3o","sequence":"additional","affiliation":[]},{"given":"Ana Maria","family":"Rodrigues","sequence":"additional","affiliation":[]}],"member":"1965","published-online":{"date-parts":[[2024,4,24]]},"reference":[{"key":"ref1","first-page":"1789","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: A systematic analysis for the global burden of disease study 2017","volume-title":"Lancet","year":"2018"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/j.amepre.2011.10.026","article-title":"Obesity and severe obesity forecasts through 2030","volume":"42","author":"Finkelstein","year":"2012","journal-title":"Am J Prev Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1431","DOI":"10.1038\/ijo.2008.102","article-title":"Global burden of obesity in 2005 and projections to 2030","volume":"32","author":"Kelly","year":"2008","journal-title":"Int J Obes"},{"volume-title":"WHO European regional obesity report 2022","year":"2022","key":"ref4"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s12913-020-06051-2","article-title":"Beyond weight: examining the association of obesity with cardiometabolic related inpatient costs among Canadian adults using linked population based survey and hospital administrative data","volume":"21","author":"Gupta","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1186\/1471-2458-13-544","article-title":"Hospitalization rates and cost in severe or complicated obesity: an Italian cohort study","volume":"13","author":"Migliore","year":"2013","journal-title":"BMC Public Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1016\/j.cgh.2018.07.004","article-title":"Obesity is independently associated with higher annual burden and costs of hospitalization in patients with inflammatory bowel diseases","volume":"17","author":"Nguyen","year":"2019","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1046\/j.1467-789x.2001.00037.x","article-title":"The medical-care cost burden of obesity","volume":"2","author":"Thompson","year":"2001","journal-title":"Obes Rev"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1111\/j.1467-789X.2009.00712.x","article-title":"The economic burden of obesity worldwide: a systematic review of the direct costs of obesity","volume":"12","author":"Withrow","year":"2011","journal-title":"Obes Rev"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1111\/j.1467-789X.2007.00394.x","article-title":"The burden of overweight and obesity-related ill health in the UK","volume":"8","author":"Allender","year":"2007","journal-title":"Obes Rev"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1111\/j.1524-4733.2005.00048.x","article-title":"Obesity, survival, and hospital costs\u2014findings from a screening project in Sweden","volume":"8","author":"Borg","year":"2005","journal-title":"Value Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1007\/s10198-010-0242-6","article-title":"Health burden and costs of obesity and overweight in Germany","volume":"12","author":"Konnopka","year":"2011","journal-title":"Eur J Health Econ"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1472-6963-8-88","article-title":"Length of stay and associated costs of obesity related hospital admissions in Ireland","volume":"8","author":"Vellinga","year":"2008","journal-title":"BMC Health Serv Res"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e13535","DOI":"10.1111\/obr.13535","article-title":"Economic burden of childhood overweight and obesity: a systematic review and meta-analysis","volume":"24","author":"Ling","year":"2023","journal-title":"Obes Rev"},{"key":"ref15","first-page":"99","article-title":"Custos da obesidade em Portugal","volume":"4","author":"Pereira","year":"1999","journal-title":"Documento de trabalho"},{"year":"2022","key":"ref16"},{"year":"2020","key":"ref17"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1741","DOI":"10.1093\/ije\/dyy185","article-title":"Cohort profile: the epidemiology of chronic diseases cohort (EpiDoC)","volume":"47","author":"Dias","year":"2018","journal-title":"Int J Epidemiol"},{"year":"2018","key":"ref19"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"260","DOI":"10.5694\/j.1326-5377.2010.tb03503.x","article-title":"The cost of overweight and obesity in Australia","volume":"192","author":"Colagiuri","year":"2010","journal-title":"Med J Aust"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e12442","DOI":"10.1111\/cob.12442","article-title":"Costs of the COVID-19 pandemic associated with obesity in Europe: a health-care cost model","volume":"11","author":"Czernichow","year":"2021","journal-title":"Clin Obes"},{"year":"2018","key":"ref22"},{"year":"1995","key":"ref23"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1037\/hea0000739","article-title":"The measurement of multimorbidity","volume":"38","author":"Nicholson","year":"2019","journal-title":"Health Psychol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2458-13-1161","article-title":"Multimorbidity prevalence in the general population: the role of obesity in chronic disease clustering","volume":"13","author":"Agborsangaya","year":"2013","journal-title":"BMC Public Health"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"100348","DOI":"10.1016\/j.obmed.2021.100348","article-title":"The concurrent burden of multimorbidity, mental health conditions, and severe obesity among United States health center patients","volume":"24","author":"Babey","year":"2021","journal-title":"Obesity Med"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.archger.2007.02.005","article-title":"Hospital admissions among people 65+ related to multimorbidity, municipal and outpatient care","volume":"46","author":"Condelius","year":"2008","journal-title":"Arch Gerontol Geriatr"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1111\/j.1532-5415.2011.03827.x","article-title":"Health consequences associated with being overweight or obese: a Swedish population-based study of 85-year-olds","volume":"60","author":"Dong","year":"2012","journal-title":"J Am Geriatr Soc"},{"year":"2022","key":"ref29"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1093\/eurpub\/cku170","article-title":"Economic impact of adult obesity on health systems: a systematic review","volume":"25","author":"Specchia","year":"2015","journal-title":"Eur J Pub Health"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1177\/002214650704800407","article-title":"Obesity and hospitalization over the adult life course: does duration of exposure increase use?","volume":"48","author":"Schafer","year":"2007","journal-title":"J Health Soc Behav"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1016\/j.mayocp.2021.01.021","article-title":"Obesity is a major risk factor for hospitalization in community-managed COVID-19 pneumonia","volume":"96","author":"Cottini","year":"2021","journal-title":"Mayo Clin Proc"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1080\/15412555.2020.1781805","article-title":"Patients with obesity have better long-term outcomes after hospitalization for COPD exacerbation","volume":"17","author":"DeLapp","year":"2020","journal-title":"COPD"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-020-05620-9","article-title":"Defining ambulatory care sensitive conditions for adults in Portugal","volume":"20","author":"Sarmento","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1232","DOI":"10.1007\/s11999-013-3316-9","article-title":"Obesity increases length of stay and direct medical costs in total hip arthroplasty","volume":"472","author":"Maradit Kremers","year":"2014","journal-title":"Clin Orthop Relat Res"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1097\/MLR.0b013e3181ca3d85","article-title":"The impact of severe obesity on hospital length of stay","volume":"48","author":"Hauck","year":"2010","journal-title":"Med Care"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1587","DOI":"10.2105\/AJPH.94.9.1587","article-title":"Length of hospital stays among obese individuals","volume":"94","author":"Zizza","year":"2004","journal-title":"Am J Public Health"},{"year":"2020","key":"ref38"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2458-12-440","article-title":"The costs of overweight and obesity-related diseases in the Brazilian public health system: cross-sectional study","volume":"12","author":"Bahia","year":"2012","journal-title":"BMC Public Health"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1007\/s10198-021-01358-1","article-title":"The economic burden of obesity in Italy: a cost-of-illness study","volume":"23","author":"d\u2019Errico","year":"2022","journal-title":"Eur J Health Econ"},{"volume-title":"The economic burden of obesity -OECD Health Policy Studies","year":"2019","author":"Vuik","key":"ref41"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1016\/j.maturitas.2011.04.005","article-title":"Economic costs of adult obesity: a review of recent European studies with a focus on subgroup-specific costs","volume":"69","author":"von Lengerke","year":"2011","journal-title":"Maturitas"},{"key":"ref43","doi-asserted-by":"crossref","DOI":"10.1596\/978-1-4648-1491-4","volume-title":"Obesity: Health and economic consequences of an impending global challenge","author":"Shekar","year":"2020"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.annepidem.2019.09.007","article-title":"Errors in body mass index from self-reported data by sex and across waves of add health","volume":"39","author":"Ng","year":"2019","journal-title":"Ann Epidemiol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"e000166","DOI":"10.1136\/rmdopen-2015-000166","article-title":"Prevalence of rheumatic and musculoskeletal diseases and their impact on health-related quality of life, physical function and mental health in Portugal: results from EpiReumaPt\u2013a national health survey","volume":"2","author":"Branco","year":"2016","journal-title":"RMD Open"},{"key":"ref46","first-page":"110","article-title":"EpiReumaPt-the study of rheumatic and musculoskeletal diseases in Portugal","volume":"40","author":"Rodrigues","year":"2015","journal-title":"Acta reumatologica portuguesa"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1380690\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T04:22:14Z","timestamp":1713932534000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1380690\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,24]]},"references-count":46,"alternative-id":["10.3389\/fpubh.2024.1380690"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1380690","relation":{},"ISSN":["2296-2565"],"issn-type":[{"type":"electronic","value":"2296-2565"}],"subject":[],"published":{"date-parts":[[2024,4,24]]},"article-number":"1380690"}}