Lower Vegetable Variety and Worsening Diet Quality Over Time Are Associated With Higher 15-Year Health Care Claims and Costs Among Australian Women

Jennifer N Baldwin; Peta M Forder; Rebecca Haslam; Alexis Hure; Deborah Loxton; Amanda J Patterson; Clare E Collins

doi:10.1016/j.jand.2020.12.012

Lower Vegetable Variety and Worsening Diet Quality Over Time Are Associated With Higher 15-Year Health Care Claims and Costs Among Australian Women

J Acad Nutr Diet. 2021 Apr;121(4):655-668. doi: 10.1016/j.jand.2020.12.012. Epub 2021 Jan 22.

Authors

Jennifer N Baldwin¹, Peta M Forder², Rebecca Haslam¹, Alexis Hure³, Deborah Loxton², Amanda J Patterson¹, Clare E Collins⁴

Affiliations

¹ (1)The University of Newcastle Faculty of Health and Medicine, Callaghan, NSW, Australia; (2)The University of Newcastle Priority Research Centre for Physical Activity and Nutrition, Callaghan, NSW, Australia.
² (3)The University of Newcastle Priority Research Centre for Generational Health and Ageing, New Lambton, New South Wales, Australia.
³ (4)The University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia.
⁴ (1)The University of Newcastle Faculty of Health and Medicine, Callaghan, NSW, Australia; (2)The University of Newcastle Priority Research Centre for Physical Activity and Nutrition, Callaghan, NSW, Australia. Electronic address: clare.collins@newcastle.edu.au.

PMID: 33487591
DOI: 10.1016/j.jand.2020.12.012

Abstract

Background: The relationship between diet quality and health care costs is unclear.

Objective: The aim of this study was to investigate the relationship between baseline diet quality and change in diet quality over time, with 15-year cumulative health care claims/costs.

Design: Data from a longitudinal cohort study were analyzed.

Participants/setting: Data for survey 3 (2001) (n = 7,868) and survey 7 (2013) (n = 6,349 both time points) from the 1946-1951 cohort of the Australian Longitudinal Study on Women's Health were analyzed.

Main outcome measures: Diet quality was assessed using the Australian Recommended Food Score (ARFS). Fifteen-year cumulative Medicare Benefits Schedule (Australia's universal health care coverage) data were reported by baseline ARFS quintile and category of diet quality change ("diet quality worsened" [ARFS change ≤ -4 points], "remained stable" [-3 ≤ change in ARFS ≤3 points], or "improved" [ARFS change ≥4 points]).

Statistical analyses: Linear regression analyses were conducted adjusting for area of residence, socioeconomic status, lifestyle factors, and private health insurance status.

Results: Consuming a greater variety of vegetables at baseline but fewer fruit and dairy products was associated with lower health care costs. For every 1-point increment in the ARFS vegetable subscale, women made 3.3 (95% CI, 1.6-5.0) fewer claims and incurred AU$227 (95% CI, AU$104-350 [US$158; 95% CI, US$72-243]) less in costs. Women whose diet quality worsened over time made more claims (median, 251 claims; quintile 1, quintile 3 [Q1; Q3], 168; 368 claims) and incurred higher costs (AU$15,519; Q1; Q3, AU$9,226; AU$24,847 [US$10,793; Q1; Q3, US$6,417; US$17,281]) compared with those whose diet quality remained stable (median, 236 claims [Q1; Q3, 158; 346 claims], AU$14,515; Q1; Q3, AU$8,539; AU$23,378 [US$10,095; Q1; Q3, US$5,939; US$16,259]).

Conclusions: Greater vegetable variety was associated with fewer health care claims and costs; however, this trend was not consistent across other subscales. Worsening diet quality over 12 years was linked with higher health care claims and costs.

Keywords: Body mass index; Diet quality; Health care costs; Women’s health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Australia
Cohort Studies
Diet / economics*
Diet / standards*
Diet / trends*
Female
Health Care Costs / trends*
Humans
Insurance Benefits / economics*
Longitudinal Studies
Middle Aged
National Health Programs / economics*
Vegetables
Women's Health