{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:59:25Z","timestamp":1785405565956,"version":"3.56.0"},"reference-count":37,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:00:00Z","timestamp":1783123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004071","name":"Khon Kaen University","doi-asserted-by":"publisher","award":["FF2569"],"award-info":[{"award-number":["FF2569"]}],"id":[{"id":"10.13039\/501100004071","id-type":"DOI","asserted-by":"publisher"}]},{"award":["FF2569"],"award-info":[{"award-number":["FF2569"]}],"id":[{"id":"https:\/\/ror.org\/03cq4gr50","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: While pediatric obesity prevalence is rising, the association between ICD-coded obesity, healthcare resource utilization, and inpatient outcomes in middle-income countries remains poorly quantified. This study examined inpatient diagnostic patterns, resource utilization, and in-hospital mortality among hospitalized pediatric patients with ICD-coded obesity in Thailand\u2019s Universal Coverage scheme during a 9-year period. Methods: We analyzed nationwide inpatient administrative data from January 2015 to December 2023 for children aged 1 month to &lt;18 years. ICD-coded obesity was defined using ICD-10-TM codes recorded as either a principal diagnosis or a comorbidity. Outcomes included length of stay, hospital costs, and in-hospital mortality. Univariable and multivariable regression models were used to estimate associations between ICD-coded obesity and inpatient outcomes, with adjustment for age, sex, region, hospital level, admission year, and disease categories. Results: Among 14,483,566 hospitalized children, 42,168 had ICD-coded obesity. Notably, 95.7% of children with ICD-coded obesity were recorded as a comorbidity rather than the primary reason for admission. Children with ICD-coded obesity as a comorbidity had 156.8% higher median hospital costs. Across all major categories of common acute diseases (respiratory, intestinal, digestive), children with ICD-coded obesity had significantly higher median costs and longer length of stay compared to children without ICD-coded obesity. In regression analyses, ICD-coded obesity remained associated with longer length of stay (adjusted ratio, 1.21; 95% CI, 1.16\u20131.26; p &lt; 0.001) and higher hospitalization cost (adjusted cost ratio, 1.42; 95% CI, 1.32\u20131.53; p &lt; 0.001). The association with in-hospital mortality was observed in the unadjusted model but was attenuated after adjustment and was not statistically significant (adjusted odds ratio, 1.14; 95% CI, 0.89\u20131.45; p = 0.303). Conclusions: In Thailand\u2019s national universal coverage scheme, ICD-coded obesity was associated with greater inpatient resource utilization, especially longer length of stay and higher hospitalization costs. These findings support the need for weight-aware inpatient management and adjusted funding models for hospitals treating this higher-resource-utilization subgroup.<\/jats:p>","DOI":"10.3390\/diseases14070242","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T10:43:11Z","timestamp":1783334591000},"page":"242","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Economic and Clinical Burden of Pediatric Obesity Within a Universal Health Coverage System in Thailand: A 9-Year Nationwide Analysis of 14.5 Million Hospitalizations"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0090-7289","authenticated-orcid":false,"given":"Tran Cong","family":"Ly","sequence":"first","affiliation":[{"name":"Doctor of Philosophy Program in Clinical Sciences, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand"},{"name":"Department of Pediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 94120, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1368-9508","authenticated-orcid":false,"given":"Suchaorn","family":"Saengnipanthkul","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1245-837X","authenticated-orcid":false,"given":"Phanthila","family":"Sitthikarnkha","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4668-6792","authenticated-orcid":false,"given":"Leelawadee","family":"Techasatian","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1782-9360","authenticated-orcid":false,"given":"Kaewjai","family":"Thepsuthammarat","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pope","family":"Kosalaraksa","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1903-0907","authenticated-orcid":false,"given":"Rattapon","family":"Uppala","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1016\/S0140-6736(25)00260-0","article-title":"Forecasting the Global Obesity Epidemic through 2050","volume":"405","year":"2025","journal-title":"Lancet"},{"key":"ref_2","unstructured":"NCD Risk Factor Collaboration (NCD-RisC) (2017). Worldwide Trends in Body-Mass Index, Underweight, Overweight, and Obesity from 1975 to 2016: A Pooled Analysis of 2416 Population-Based Measurement Studies in 128\u00b79 Million Children, Adolescents, and Adults. Lancet, 390, 2627\u20132642."},{"key":"ref_3","unstructured":"World Health Organization (2026, January 01). Thailand\u2019s Leadership in the Fight Against Obesity. Available online: https:\/\/www.who.int\/thailand\/news\/feature-stories\/detail\/thailand-s-leadership-in-the-fight-against-obesity."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e2022060640","DOI":"10.1542\/peds.2022-060640","article-title":"Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity","volume":"151","author":"Hampl","year":"2023","journal-title":"Pediatrics"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1007\/s00431-022-04689-0","article-title":"Obesity as a Risk Factor for Severe Influenza Infection in Children and Adolescents: A Systematic Review and Meta-Analysis","volume":"182","author":"Vitoratou","year":"2023","journal-title":"Eur. J. Pediatr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1001\/jamapediatrics.2015.132","article-title":"Drug Dosing and Pharmacokinetics in Children with Obesity: A Systematic Review","volume":"169","author":"Hill","year":"2015","journal-title":"JAMA Pediatr."},{"key":"ref_7","first-page":"81","article-title":"Medication Dosage in Overweight and Obese Children","volume":"22","author":"Matson","year":"2017","journal-title":"J. Pediatr. Pharmacol. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1097\/MLR.0000000000001346","article-title":"Hospital Length of Stay, Charges, and Costs Associated with a Diagnosis of Obesity in US Children and Youth, 2006-2016","volume":"58","author":"Kompaniyets","year":"2020","journal-title":"Med. Care"},{"key":"ref_9","first-page":"91","article-title":"A Comparison of Length of Hospitalization and Costs in Obese and Non-Obese Pediatric Patients at a Single Hospital in Honolulu","volume":"79","author":"Davis","year":"2020","journal-title":"Hawaii J. Health Soc. Welf."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.1038\/oby.2007.224","article-title":"Incremental Hospital Charges Associated with Obesity as a Secondary Diagnosis in Children","volume":"15","author":"Woolford","year":"2007","journal-title":"Obesity"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Ly, T.C., Saengnipanthkul, S., Sitthikarnkha, P., Techasatian, L., Uppala, R., and Kosalaraksa, P. (2026). Nationwide Trends in Pediatric Obesity in Thailand, 2015\u20132023: Prevalence, Morbidity, Mortality, and COVID-19\u2013Related Disparities. BMC Public Health, 26.","DOI":"10.1186\/s12889-026-26570-7"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e152","DOI":"10.1017\/S1368980024000053","article-title":"South East Asian Nutrition Surveys II (SEANUTS II) Thailand: Triple Burden of Malnutrition among Thai Children Aged 6 Months to 12 Years","volume":"27","author":"Pongcharoen","year":"2024","journal-title":"Public Health Nutr."},{"key":"ref_13","unstructured":"Centers for Disease Control and Prevention (CDC) (2025, December 02). Childhood Obesity Facts, Available online: https:\/\/www.cdc.gov\/obesity\/childhood-obesity-facts\/childhood-obesity-facts.html."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Nilson, E.A.F., da Costa, M.G., de Oliveira, A.C.R., Honorio, O.S., and da Concei\u00e7\u00e3o Barbosa, R.B. (2025). Trends in the Prevalence of Obesity and Estimation of the Direct Health Costs Attributable to Child and Adolescent Obesity in Brazil from 2013 to 2022. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0308751"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Jia, S., Ye, X., Wu, T., Wang, Z., and Wu, J. (2025). Global Prevalence of Metabolic Dysfunction-Associated Fatty Liver Disease in Children and Adolescents with Overweight and Obesity: A Systematic Review and Meta-Analysis. BMC Gastroenterol., 25.","DOI":"10.1186\/s12876-025-04314-y"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1001\/jamapediatrics.2025.2206","article-title":"Global Prevalence of Hypertension in Children and Adolescents Younger Than 19 Years: A Systematic Review and Meta-Analysis","volume":"179","author":"Ruan","year":"2025","journal-title":"JAMA Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1007\/s11906-025-01329-4","article-title":"Hypertension, Obesity, and Target Organ Injury in Children: An Emerging Health Care Crisis","volume":"27","author":"Tran","year":"2025","journal-title":"Curr. Hypertens. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.jped.2020.08.006","article-title":"Vitamin D Deficiency in Children and Adolescents with Obesity: A Meta-Analysis","volume":"97","author":"Fiamenghi","year":"2021","journal-title":"J. Pediatr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.jsbmb.2016.08.004","article-title":"Physiological Functions of Vitamin D in Adipose Tissue","volume":"165","author":"Abbas","year":"2017","journal-title":"J. Steroid Biochem. Mol. Biol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kozio\u0142-Kozakowska, A., W\u00f3jcik, M., Stochel-Gaudyn, A., Szczudlik, E., Suder, A., and Pi\u00f3recka, B. (2022). The Severity of Obesity Promotes Greater Dehydration in Children: Preliminary Results. Nutrients, 14.","DOI":"10.3390\/nu14235150"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Kuhle, S., Kirk, S.F.L., Ohinmaa, A., and Veugelers, P.J. (2011). Comparison of ICD Code-Based Diagnosis of Obesity with Measured Obesity in Children and the Implications for Health Care Cost Estimates. BMC Med. Res. Methodol., 11.","DOI":"10.1186\/1471-2288-11-173"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1089\/chi.2024.0267","article-title":"Who Gets a Code for Obesity? Reliability, Use, and Implications of Combining International Classification of Diseases-Based Obesity Codes, 2014\u20132021","volume":"21","author":"Kompaniyets","year":"2025","journal-title":"Child. Obes."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Tao, C., Fortune, M., Webb, E.A., and Polychronakis, T. (2025). Risk Factors for Obstructive Sleep Apnoea in Obese Children: A Systematic Review and Meta-Analysis. Paediatr. Respir. Rev.","DOI":"10.1016\/j.prrv.2025.12.003"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.jpeds.2008.09.022","article-title":"Obesity Identified by Discharge ICD-9 Codes Underestimates the True Prevalence of Obesity in Hospitalized Children","volume":"154","author":"Woo","year":"2009","journal-title":"J. Pediatr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1177\/0885066616631325","article-title":"Influence of Obesity Diagnosis with Organ Dysfunction, Mortality, and Resource Use Among Children Hospitalized with Infection in the United States","volume":"32","author":"Maley","year":"2017","journal-title":"J. Intensive Care Med."},{"key":"ref_26","doi-asserted-by":"crossref","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":"ref_27","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1001\/jamapediatrics.2013.13","article-title":"Influence of Obesity on Clinical Outcomes in Hospitalized Children: A Systematic Review","volume":"167","author":"Bechard","year":"2013","journal-title":"JAMA Pediatr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1038\/s41366-019-0319-y","article-title":"Association of Obesity with Morbidity and Mortality in Critically Ill Children: A Systematic Review and Meta-Analysis of Observational Studies","volume":"43","author":"Alipoor","year":"2019","journal-title":"Int. J. Obes."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e20152035","DOI":"10.1542\/peds.2015-2035","article-title":"Obesity and Mortality Risk in Critically Ill Children","volume":"137","author":"Ross","year":"2016","journal-title":"Pediatrics"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1111\/crj.12694","article-title":"The Impact of Pediatric Obesity on Hospitalized Children with Lower Respiratory Tract Infections in the United States","volume":"12","author":"Okubo","year":"2018","journal-title":"Clin. Respir. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1097\/MOP.0000000000000953","article-title":"Obesity and Immune Status in Children","volume":"32","author":"Fang","year":"2020","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1038\/ni.2343","article-title":"Immunological Complications of Obesity","volume":"13","author":"Kanneganti","year":"2012","journal-title":"Nat. Immunol."},{"key":"ref_33","first-page":"94","article-title":"Pharmacokinetics and Drug Dosing in Obese Children","volume":"15","author":"Kendrick","year":"2010","journal-title":"J. Pediatr. Pharmacol. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1515\/jpem-2018-0110","article-title":"Childhood Obesity: How Long Should We Wait to Predict Weight?","volume":"31","author":"Butler","year":"2018","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1055\/s-0041-1731035","article-title":"Evaluation and Management of Early Onset Genetic Obesity in Childhood","volume":"10","author":"Malhotra","year":"2021","journal-title":"J. Pediatr. Genet."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1172\/JCI88882","article-title":"The Initiation of Metabolic Inflammation in Childhood Obesity","volume":"127","author":"Singer","year":"2017","journal-title":"J. Clin. Investig."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e35673","DOI":"10.1002\/cncr.35673","article-title":"Impact of Obesity on Outcome in Children Diagnosed with Cancer in Canada: A Report from Cancer in Young People in Canada","volume":"131","author":"Sassine","year":"2025","journal-title":"Cancer"}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/7\/242\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T12:08:37Z","timestamp":1783339717000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/7\/242"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,4]]},"references-count":37,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["diseases14070242"],"URL":"https:\/\/doi.org\/10.3390\/diseases14070242","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,4]]}}}