Publications

The relationship of obesity to hospice use and expenditures: A cohort study

Background:Obesity complicates medical, nursing, and informal care in severe illness, but its effect on hospice use and Medicare expenditures is unknown.Objective:To describe the associations between body mass index (BMI) and hospice use and Medicare expenditures in the last 6 months of life.Design:Retrospective cohort.Setting:The HRS (Health and Retirement Study).Participants:5677 community-dwelling Medicare fee-for-service beneficiaries who died between 1998 and 2012.Measurements:Hospice enrollment, days enrolled in hospice, in-home death, and total Medicare expenditures in the 6 months before death. BMI was modeled as a continuous variable with a quadratic functional form.Results:For decedents with BMI of 20 kg/m2, the predicted probability of hospice enrollment was 38.3% (95% CI, 36.5% to 40.2%), hospice duration was 42.8 days (CI, 42.3 to 43.2 days), probability of in-home death was 61.3% (CI, 59.4% to 63.2%), and total Medicare expenditures were $42 803 (CI, $41 085 to $44 521). When BMI increased to 30 kg/m2, the predicted probability of hospice enrollment decreased by 6.7 percentage points (CI, âˆ'9.3 to âˆ'4.0 percentage points), hospice duration decreased by 3.8 days (CI, âˆ'4.4 to âˆ'3.1 days), probability of in-home death decreased by 3.2 percentage points (CI, âˆ'6.0 to âˆ'0.4 percentage points), and total Medicare expenditures increased by $3471 (CI, $955 to $5988). For morbidly obese decedents (BMI ≥40 kg/m2), the predicted probability of hospice enrollment decreased by 15.2 percentage points (CI, âˆ'19.6 to âˆ'10.9 percentage points), hospice duration decreased by 4.3 days (CI, âˆ'5.7 to âˆ'2.9 days), and in-home death decreased by 6.3 percentage points (CI, âˆ'11.2 to âˆ'1.5 percentage points) versus decedents with BMI of 20 kg/m2.Limitation:Baseline data were self-reported, and the interval between reported BMI and time of death varied.Conclusion:Among community-dwelling decedents in the HRS, increasing obesity was associated with reduced hospice use and in-home death and higher Medicare expenditures in the last 6 months of life.Primary Funding Source:Robert Wood Johnson Foundation Clinical Scholars Program.