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Mendelian randomization: estimation of inpatient hospital costs attributable to obesity.
Health Economics Review ( IF 2.118 ) Pub Date : 2021-05-14 , DOI: 10.1186/s13561-021-00314-2
Katherine Dick 1 , John E Schneider 1 , Andrew Briggs 1, 2 , Pascal Lecomte 3 , Stephane A Regnier 3 , Michael Lean 4
Affiliation  

BACKGROUND Mendelian Randomization is a type of instrumental variable (IV) analysis that uses inherited genetic variants as instruments to estimate causal effects attributable to genetic factors. This study aims to estimate the impact of obesity on annual inpatient healthcare costs in the UK using linked data from the UK Biobank and Hospital Episode Statistics (HES). METHODS UK Biobank data for 482,127 subjects was linked with HES inpatient admission records, and costs were assigned to episodes of care. A two-stage least squares (TSLS) IV model and a TSLS two-part cost model were compared to a naïve regression of inpatient healthcare costs on body mass index (BMI). RESULTS The naïve analysis of annual cost on continuous BMI predicted an annual cost of £21.61 [95% CI £20.33 - £22.89] greater cost per unit increase in BMI. The TSLS IV model predicted an annual cost of £14.36 [95% CI £0.31 - £28.42] greater cost per unit increase in BMI. Modelled with a binary obesity variable, the naïve analysis predicted that obese subjects incurred £205.53 [95% CI £191.45 - £219.60] greater costs than non-obese subjects. The TSLS model predicted a cost £201.58 [95% CI £4.32 - £398.84] greater for obese subjects compared to non-obese subjects. CONCLUSIONS The IV models provide evidence for a causal relationship between obesity and higher inpatient healthcare costs. Compared to the naïve models, the binary IV model found a slightly smaller marginal effect of obesity, and the continuous IV model found a slightly smaller marginal effect of a single unit increase in BMI.

中文翻译:

孟德尔随机化:估计可归因于肥胖的住院费用。

背景孟德尔随机化是一种工具变量(IV)分析,它使用遗传的遗传变异作为工具来估计可归因于遗传因素的因果效应。本研究旨在使用来自英国生物银行和医院事件统计 (HES) 的关联数据来估计肥胖对英国年度住院医疗保健费用的影响。方法 482,127 名受试者的英国生物银行数据与 HES 住院记录相关联,并将费用分配给护理事件。将两阶段最小二乘 (TSLS) IV 模型和 TSLS 两部分成本模型与住院医疗保健成本对体重指数 (BMI) 的朴素回归进行了比较。结果 对连续 BMI 的年度成本的幼稚分析预测,每增加 BMI 单位,年度成本会增加 21.61 英镑 [95% CI 20.33 英镑 - 22.89 英镑]。TSLS IV 模型预测 BMI 增加的每单位成本每年增加 14.36 英镑 [95% CI 0.31 英镑 - 28.42 英镑]。用二元肥胖变量建模,天真的分析预测肥胖受试者比非肥胖受试者产生的成本高出 205.53 英镑 [95% CI 191.45 英镑 - 219.60 英镑]。与非肥胖受试者相比,TSLS 模型预测肥胖受试者的成本为 201.58 英镑 [95% CI 4.32 - 398.84 英镑]。结论 IV 模型为肥胖与较高的住院医疗费用之间的因果关系提供了证据。与幼稚模型相比,二元 IV 模型发现肥胖的边际效应略小,而连续 IV 模型发现 BMI 增加一个单位的边际效应略小。用二元肥胖变量建模,天真的分析预测肥胖受试者比非肥胖受试者产生的成本高出 205.53 英镑 [95% CI 191.45 英镑 - 219.60 英镑]。与非肥胖受试者相比,TSLS 模型预测肥胖受试者的成本为 201.58 英镑 [95% CI 4.32 - 398.84 英镑]。结论 IV 模型为肥胖与较高的住院医疗费用之间的因果关系提供了证据。与幼稚模型相比,二元 IV 模型发现肥胖的边际效应略小,而连续 IV 模型发现 BMI 增加一个单位的边际效应略小。用二元肥胖变量建模,天真的分析预测肥胖受试者比非肥胖受试者产生的成本高出 205.53 英镑 [95% CI 191.45 英镑 - 219.60 英镑]。与非肥胖受试者相比,TSLS 模型预测肥胖受试者的成本为 201.58 英镑 [95% CI 4.32 - 398.84 英镑]。结论 IV 模型为肥胖与较高的住院医疗费用之间的因果关系提供了证据。与幼稚模型相比,二元 IV 模型发现肥胖的边际效应略小,而连续 IV 模型发现 BMI 增加一个单位的边际效应略小。84] 与非肥胖受试者相比,肥胖受试者更大。结论 IV 模型为肥胖与较高的住院医疗费用之间的因果关系提供了证据。与幼稚模型相比,二元 IV 模型发现肥胖的边际效应略小,而连续 IV 模型发现 BMI 增加一个单位的边际效应略小。84] 与非肥胖受试者相比,肥胖受试者更大。结论 IV 模型为肥胖与较高的住院医疗费用之间的因果关系提供了证据。与幼稚模型相比,二元 IV 模型发现肥胖的边际效应略小,而连续 IV 模型发现 BMI 增加一个单位的边际效应略小。
更新日期:2021-05-14
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