Burden of Underweight in Israel

Abstract

Background: This study measures the burden of chronic diseases associated with being underweight.

Methods: Underweight prevalence in the community was obtained from national survey data, together with hospital use rates for malnourished and non-malnourished persons for diagnoses associated with underweight. Meta-analyses of published literature calculated the following disease-specific relative risks: incidence of underweight-associated disease (UAD), mortality from UAD, and all-cause and disease-specific mortality after hospitalization in underweight persons. This enabled the calculation of hospital days, deaths, and disability-adjusted life years (DALYs) attributable to underweight deconstructed into UAD and disease-associated underweight (DAU). Cost estimates were based on general hospitalization costs adjusted by estimates of pharmaceutical and other direct care costs.

Results: We found 60,401 (95% confidence interval [CI]: 58,257-63,095) general hospital days, 558 (95% CI: 219-879) deaths, 5258 (95% CI: 2174-8382) potential years of life lost, and 3390 lost DALYs (95% CI: 1511-5333) were attributable to underweight annually in Israeli adults aged ≥18 years. Annually, direct health costs amounted to $145.6 million (95% CI: $141.9-$150.5 million), with general hospital days accounting for $53.4 million, pharmaceuticals $18.2 million, and other direct healthcare costs $73.9 million. Musculoskeletal disorders accounted for nearly half of these costs with coronary heart disease, chronic obstructive pulmonary disease, and stroke accounting for 15.4%, 10.3%, and 9.3%, respectively.

Conclusions: Underweight imposes a considerable health burden in terms of deaths, health service use, and resource costs in Israel. Identification of cost-effective interventions to reduce this burden, not only among hospitalized patients, but also among persons living in the community, is essential.

Keywords: disease burden; disease-associated underweight; underweight associated disease.