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PubMed2006

Daily activity energy expenditure and mortality among older adults.

CONTEXT: Exercise is associated with mortality benefits but simply expending energy through any activity in an individual's free-living environment may confer survival advantages. OBJECTIVE: To determine whether free-living activity energy expenditure is associated with all-cause mortality among older adults. DESIGN, SETTING, AND PARTICIPANTS: Free-living activity energy expenditure was assessed in 302 high-functioning, community-dwelling older adults (aged 70-82 years). Total energy expenditure was assessed over 2 weeks using doubly labeled water. Resting metabolic rate was measured using indirect calorimetry and the thermic effect of meals was estimated at 10% of total energy expenditure. Free-living activity energy expenditure was calculated as: (total energy expenditure x 0.90) - resting metabolic rate. Participants were followed up over a mean of 6.15 years (1998-2006). MAIN OUTCOME MEASURES: Free-living activity energy expenditure (3 tertiles: low, <521 kcal/d; middle, 521-770 kcal/d; high, >770 kcal/d) and all-cause mortality. RESULTS: Fifty-five participants (18.2%) died during follow-up. As a continuous risk factor, an SD increase in free-living activity energy expenditure (287 kcal/d) was associated with a 32% lower risk of mortality after adjusting for age, sex, race, study site, weight, height, percentage of body fat, and sleep duration (hazard ratio, 0.68; 95% confidence interval, 0.48-0.96). Using the same adjustments, individuals in the highest tertile of free-living activity energy expenditure were at a significantly lower mortality risk compared with the lowest tertile (hazard ratio, 0.31; 95% confidence interval, 0.14-0.69). Absolute risk of death was 12.1% in the highest tertile of activity energy expenditure vs 24.7% in the lowest tertile; absolute risks were similar to these for tertiles of physical activity level. The effect of free-living activity energy expenditure changed little after further adjustment for self-rated health, education, prevalent health conditions, and smoking behavior. According to self-reports, individuals expending higher levels of free-living activity energy were more likely to work for pay (P = .004) and climb stairs (P = .01) but self-reported high-intensity exercise, walking for exercise, walking other than for exercise, volunteering, and caregiving did not differ significantly across the activity energy expenditure tertiles. CONCLUSIONS: Objectively measured free-living activity energy expenditure was strongly associated with lower risk of mortality in healthy older adults. Simply expending energy through any activity may influence survival in older adults.

Activities of Daily Living↗
PubMedDate not supplied

The association between body mass and health care expenditures.

With several studies estimating the health care costs attributable to obesity-related medical conditions, the economic consequences of being overweight are beginning to come into focus. The present study complements this growing body of literature by directly estimating health care costs across a broad range of body mass index values. Data were obtained from the 1987 National Medical Expenditure Survey (NMES) public use data tapes and retrospective analyses conducted on NMES Household Survey data only. The analyses included a total of 16,217 individuals between the ages of 18 and 65. Four classes of health care utilization and expenditures were derived using the NMES data: (1) use of any health care service and total health care expenditures, (2) use of inpatient services and inpatient expenditures, (3) use of outpatient services and outpatient expenditures, and (4) use of prescription medication and medication expenditures. Estimates based on our findings suggested strong relationships between body mass and the likelihood of using health care services and between body mass and average annual health care expenditures for both men and women. Increased body mass was associated with increased expenditures. However, this association was greater among males than among females and did not hold for individuals in the lowest body mass category. Ideal body mass was associated with 6.3% to 36.1% lower annual health care expenditures among females and 3.6% to 18.2% lower health care expenditures among males. The results of this set of analyses suggest that health care expenditures increase as weight deviates from the ideal-that is, health care expenditures among both underweight and overweight individuals in the United States were increased in relation to ideal weight. Separate analyses including weight-related diseases such as diabetes and hypertension indicated that body mass increased health care expenditures largely by increasing the risk for these costly chronic medical conditions.

Adult↗
PubMed1999

Energy expenditure and severity of injury and illness indices in multiple trauma patients.

OBJECTIVE: To determine whether the energy expenditure of mechanically ventilated multiple trauma patients correlates with the severity of injury and illness indices before important systemic infection has complicated the clinical course, and to compare the energy expenditure with the energy expenditure expected from the Harris-Benedict equation adjusted with correction factors for trauma. DESIGN: Prospective, clinical study. SETTING: General intensive care unit of a university teaching hospital. PATIENTS: Immediate multiple trauma adult patients who required mechanical ventilation. INTERVENTIONS: Metabolic cart connected to the ventilator. MEASUREMENTS AND MAIN RESULTS: Data on admission to the emergency department and during the first 24 hrs of intensive care unit admission were collected for computation of severity of injury and illness indices, respectively. Resting and total energy expenditures were derived at least 48 hrs after intensive care unit admission by continuous indirect calorimetry. Predicted basal energy expenditure was obtained using the Harris-Benedict equation and predicted total energy expenditure was calculated using the Harris-Benedict value adjusted with correction factors for trauma. Twenty-six multiple trauma adult patients completed the study. No statistically significant correlations were observed between both the resting energy expenditure and the total energy expenditure and the Injury Severity Score, Revised Trauma Score, Simplified Acute Physiologic Score II, Acute Physiology and Chronic Health Evaluation II score, and Glasgow Coma Scale score. A regression model of total energy expenditure was developed with the following variables: Harris-Benedict equation, heart rate, and minute ventilation (p = .01; r2 = .74). The resting energy expenditure/predicted basal energy expenditure ratio was 1.17+/-0.2 and the total energy expenditure/predicted total energy expenditure ratio was 0.76+/-0.1. CONCLUSIONS: In mechanically ventilated multiple trauma patients the energy expenditure is not correlated to the severity of injury and illness indices but is dependent on the Harris-Benedict equation in addition to heart rate and minute ventilation. Furthermore, this patient population is characterized by a moderate state of hypermetabolism, and the Harris-Benedict prediction modified with correction factors for trauma systematically overestimates the total energy expenditure.

Adult↗
PubMed2004

Variability in energy expenditure and its components.

PURPOSE OF REVIEW: To review factors contributing to variation in total daily energy expenditure and its primary components: (1) resting metabolic rate; (2) diet-induced thermogenesis; and (3) activity thermogenesis, including exercise energy expenditure and nonexercise activity. For each component, the expected magnitude of intra-individual variability is also considered. We also reviewed studies that quantified the variability in 24 h energy expenditure. RECENT FINDINGS: In humans, the coefficient of variation in the components of total daily energy expenditure is around 5-8% for resting metabolic rate, 1-2% for exercise energy expenditure, and around 20% for diet-induced thermogenesis. The coefficient of variance for 24 h energy expenditure measured using a room calorimeter for resting metabolic rate is around 5-10%. Thus, these measures are all rather reproducible. Total daily energy expenditure varies several-fold in humans, not due to variation in resting metabolic rate, diet-induced thermogenesis, or exercise thermogenesis, but rather, due to variations in nonexercise activity. A variety of factors impact nonexercise activity, including occupation, environment, education, genetics, age, gender, and body composition, but little is known about the magnitude of effect. SUMMARY: Resting metabolic rate, diet-induced thermogenesis, exercise energy expenditure, and 24 h energy expenditure are highly reproducible. Coefficient of variation is smallest for exercise energy expenditure, followed by resting metabolic rate, 24 h energy expenditure, and diet-induced thermogenesis. There is considerable variability in total daily energy expenditure, largely due to variations in nonexercise activity. Although the factors that impact upon nonexercise activity are understood, their contribution to variation in total daily energy expenditure is unclear.

Basal Metabolism↗
PubMed1997

Daily energy expenditure in free-living non-institutionalized Alzheimer's patients: a doubly labeled water study.

Weight loss is common in Alzheimer's disease (AD), but its pathogenesis is poorly understood. It is unclear whether an elevated daily energy expenditure contributes to the weight loss. We tested the hypothesis that daily energy expenditure is higher in AD patients compared to healthy elderly. Thirty AD (73 +/- 8 years; Mini-Mental State Examination score: 16 +/- 8) and 103 healthy elderly (69 +/- 7 years) were characterized for daily energy expenditure and its components (resting and free-living physical activity energy expenditure) from doubly labeled water and indirect calorimetry. Fat-free mass and fat mass were measured from dual energy X-ray absorptiometry. Fat-free mass tended to be lower in AD patients (45 +/- 9 kg) versus healthy elderly (49 +/- 10 kg; p = 0.07), whereas no differences were noted in fat mass between groups. Daily energy expenditure was 14% lower in AD (1901 +/- 517 kcal/d) compared to healthy elderly (2213 +/- 513 kcal/d; p < 0.001), due to lower resting (1287 +/- 227 versus 1418 +/- 246 kcal/d; p < 0.01) and physical activity energy expenditures (425 +/- 317 versus 574 +/- 342 kcal/d; p < 0.05). No differences in energy expenditure were noted between groups after controlling for differences in body composition. Daily energy expenditure was examined in a subgroup (n = 11) of AD patients who lost significant body weight (5.6 +/- 2.3 kg) within the past year. There was a lower daily energy expenditure in cachectic AD patients (1799 +/- 474 kcal/d) versus non-cachectic patients (1960 +/- 544 kcal/d) and healthy elderly (2213 +/- 513 kcal/d; p < 0.01). Similarly, no differences in energy expenditure were noted between groups after controlling for differences in body composition. We conclude that absolute levels of daily energy expenditure are lower in AD patients due to their lower body mass. However, after taking into account differences in body composition, daily energy expenditure in AD patients is appropriate for their metabolic size. The hypothesis that elevated daily energy expenditure contributes to weight loss in AD is not supported by these findings.

Absorptiometry, Photon↗
PubMed2002

The impact of ageing on expenditures in the National Health Service.

BACKGROUND: health policy makers in many countries have expressed concern over the pressures that increased numbers of older people will exert on health care costs. Previous studies have shown that, in addition to increasing size of older populations, per capita expenditures have risen disproportionately among the old compared to the middle age groups. Documentation of such trends is essential for more accurate projection of health expenditures. OBJECTIVE: we examined detailed national age-specific expenditure trends for England and Wales, comparing findings with Canada, Japan, and Australia. METHODS: we obtained total health expenditures for each age group from the UK Department of Health for time periods 1985-87 to 1996-99. We examined changes in age-specific per capita expenditure, population demographics, and the allocation of national expenditures to the different age groups. We then determined the association of changes in population, age structure, and age-specific per capita expenditure to increases in national health care expenditure for England and Wales, comparing results to Canada, Japan, and Australia. RESULTS: per capita health expenditures in England and Wales increased by 8% for ages 65 and over, compared to 31% for ages 5-64. Hence the proportion of total expenditures allocated to the population aged 65 and over decreased from 40% to 35%, a trend most noticeable for non-acute hospital costs. Demographic shifts and population growth accounted for only 18% of the observed increases in health care expenditures in England and Wales, compared to 68%, 44%, and 34% in Japan, Canada, and Australia respectively. CONCLUSIONS: in contrast to other countries, England and Wales had slower rises in per capita costs and a decreasing proportion of national expenditures allocated to older people. These differences invite future research into the actual demand drivers of these costs.

Age Factors↗
PubMed1991

Health care expenditure in Sweden--an international comparison.

This paper analyses health care expenditure in Sweden and compares this with the corresponding expenditure in OECD countries. The definition and measurement problems of health care expenditure are discussed, new figures for the development of health care expenditure are presented and different measures of health care expenditure are provided. We found that health care expenditure has increased by about 20% in constant prices for Sweden between 1980 and 1988, but that health care expenditure as a share of the GDP has dropped during the same period in current prices. Health care expenditure disaggregated on different age groups show for Sweden that in the age group 15-64 years, health care expenditure has not increased in constant prices between 1976 and 1985, but in the oldest age group, health care expenditure has increased considerable during this period. Health care expenditure in Sweden is as high as would be expected, taking into account the degree of economic development and the growth of expenditure during the 80s, and has followed that in comparable OECD countries. However, the relative price is lower, which means that the input of real resources are greater than in other countries.

Australia↗
PubMed2004

Current and future forecasts of service use and expenditures of Medicaid-eligible schizophrenia patients in the state of Georgia.

This study linked all claims data for reimbursable medical services and drugs of a cohort of 16,227 Medicaid-eligible recipients diagnosed with schizophrenia residing in the State of Georgia, with the treatment history file and Hospital Medical Information System file of each of the ten Georgia State psychiatric hospitals (Georgia Department of Human Resources [DHR]), which do not routinely bill Medicaid for services rendered. This provided a comprehensive picture of the medical resources consumed for each schizophrenia patient, allowing determination of expenditure use patterns, as well as forecast of future medical costs. Patient-level data were aggregated by category of service and reported as costs per member per month (PMPM). Autoregressive integrated moving average time series models described the temporal pattern of expenditures for 8 years of total cost data and were used to forecast expenditures 5 years into the future. From 1990 to 1997, total cumulative expenditures were over 1.09 billion dollars, expressed in 1995 constant dollars. DHR institutional care dominated the cost of care, but expenditures significantly decreased over time. Apparently offsetting this decrease was an increase in prescription drug cost between 1990 and 1995, from 5.7 percent of total expenditures to 10.5 percent. Total Medicaid and Medicare expenditures in 1995 dollars were relatively constant at approximately 700 dollars PMPM. Prescription expenditures increased from 50 dollars in 1990 to 100 dollars PMPM in 1997 and were projected to increase to 150 dollars in 2002. Expenditures were lower for persons continuously eligible for Medicaid than for the total cohort. Trends include a significant increase in prescription expenditures over time concurrent with decreases in inpatient expenditures and relatively stable changes in community mental health center expenditures.

Adolescent↗
PubMed1985

Health expenditures in New York City, 1983.

HIGHLIGHTS OF THE STUDY. Health expenditures in New York City totalled roughly $15.7 billion in 1983. Those expenditures represented 13.5 percent of the gross city product. Expenditures for personal health care services amounted to more than $1,900 per city resident. Despite comparatively high levels of health expenditures in New York City, such expenditures have risen much less dramatically over time than health expenditures nationally; from 1976 to 1983, city expenditures increased by 74.6 percent, compared with a national increase of 137.7 percent. More than one half (55.3%) of health expenditures in the city were accounted for by public funds. Nearly 50 percent of personal care expenditures were associated with the delivery of hospital services, for which expenditures totalled $6.9 billion. Fifty-five percent of Medicaid hospital outlays and 86 percent of Medicare hospital outlays went to private sector hospitals. More than $400 per capita was spent on physicians' services in New York City in 1983. Public sources of funds accounted for more than 80 percent of the $1.7 billion in long term care services expenditures; this contrasts with a much smaller proportion of public funding for such services nationally. More details on health expenditures in New York City follow. Data sources, definitions, study methods, and limitations are described in an appendix to this report.

Data Collection↗
PubMed1999

Indirect calorimetry in mechanically ventilated infants and children: accuracy of total daily energy expenditure with 2 hour measurements.

OBJECTIVE: To determine how accurately total daily energy expenditure can be estimated from measurement periods of less than 24 h in mechanically ventilated infants and children. DESIGN: Prospective study to validate a method to determine energy expenditure. SETTING: Pediatric intensive care unit of an university hospital. PATIENTS: Nineteen ventilated patients (age 3 weeks - 13 years) with a FiO(2)of less than 60% and tube leakage < 10% (the difference between inspiratory and expiratory tidal volume measured by the ventilator). Separately, in five patients with varying tube leakage (2-59%) the influence of tube leakage on measured energy expenditure was determined. MEASUREMENT: Energy expenditure was measured by indirect calorimetry. Total daily energy expenditure measurements for 24 h were compared with 2 h energy expenditure measurements. The influence of body temperature on measured energy expenditure was determined. RESULTS: The mean coefficient of variation among 2 hour periods of measured energy expenditure was 6% (range 2-11%) compared with total daily energy expenditure measurements. The influence of body temperature revealed an increase of 6% of energy expenditure/ degrees C. An increased tube leakage influenced the energy expenditure measurements significantly (P<< 0. 001). CONCLUSION: In a clinical situation in patients with a tube leakage << 10% total daily energy expenditure can be estimated from a 2 h measurement period.

Adolescent↗
PubMed1991

Energy expenditure and substrate metabolism measured by 24 h whole-body calorimetry in patients receiving cyclic and continuous total parenteral nutrition.

1. Twenty-four hour energy expenditure and its components, i.e. 'basal metabolic rate', activity energy expenditure and diet-induced thermogenesis were measured, using continuous whole-body indirect calorimetry, in patients receiving total parenteral nutrition while in remission from Crohn's disease (weight 51.9 +/- 9.9 kg, body mass index 19.2 +/- 2.0 kg/m2). 2. Total parenteral nutrition was infused continuously over 24 h in four subjects and cyclically, between 22.00 and 10.00 hours, in eight subjects. Twenty-four hour energy expenditure (6.83 +/- 1.10 MJ/24 h) was lower than total energy intake (10.09 +/- 1.63 MJ/24 h), resulting in a positive energy balance (3.26 +/- 1.42 MJ) in all subjects. Repeated measurements of resting energy expenditure in the continuously fed subjects (5.82 +/- 1.11 MJ/24 h) did not change significantly at different times of day (coefficient of variation 2.2-6.6%). In contrast, in cyclically fed subjects, resting energy expenditure was 24.2 +/- 9.0% higher towards the end of the 12 h feeding period than the 'basal metabolic rate', which was measured just before the start of the feeding period. 3. Diet-induced thermogenesis, calculated as the increment in resting energy expenditure above 'basal metabolic rate' over the 24 h period (adjusted for the reduction in energy expenditure during sleep), was found to be 0.60 +/- 0.29 MJ or 6.1 +/- 3.1% of the energy intake. 4. The energy cost of activity (activity energy expenditure) in the continuously fed patients, calculated as the difference between 24 h energy expenditure and the integrated 24 h measurements of resting energy expenditure, was 0.88 +/- 0.53 MJ, i.e. 12.9 +/- 5.9% of the 24 h energy expenditure. 5. The non-protein non-glycerol respiratory quotient exceeded 1.0 for varying periods of time (0.5-17 h) in 11 subjects, indicating net lipogenesis from carbohydrate. 6. The results demonstrate favourable rates of deposition, during intravenous feeding, of both energy and nitrogen over a 24 h period in patients recovering from an episode of Crohn's disease. The efficacy of these commonly used total parenteral nutrition regimens in these patients is related to three features that are absent in normal healthy individuals, namely a low basal metabolic rate, a low activity-related energy expenditure and prolonged periods of lipogenesis from carbohydrate.

Adult↗
PubMed1991

Resting energy expenditure in patients with pancreatitis.

OBJECTIVE: To assess the resting energy expenditure of hospitalized patients with pancreatitis. DESIGN: Prospective, case-referent study. SETTING: Nutrition support service in a university tertiary care hospital. PATIENTS: Patients referred to the Nutrition Support Service with the diagnosis of pancreatitis. Excluded from study entry included those with cancer, obesity (greater than 150% ideal body weight), those measured within 3 postoperative days, or patients requiring ventilator support with an FIO2 of greater than 0.5. Forty-eight patients with either acute pancreatitis (n = 13), chronic pancreatitis (n = 24), acute pancreatitis with sepsis (n = 7), or chronic pancreatitis with sepsis (n = 7) were studied. The two septic groups were combined into a single pancreatitis-with-sepsis group, since no significant differences among measured variables were observed between individual septic groups. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Resting energy expenditure was measured by indirect calorimetry and compared with the predicted energy expenditure, as determined by the Harris-Benedict equations. Resting energy expenditure (percent of predicted energy expenditure) was significantly (p less than .02) greater for patients with pancreatitis complicated by sepsis (120 +/- 11%) compared with the nonseptic chronic pancreatitis group (105 +/- 14%). Resting energy expenditure for the nonseptic acute pancreatitis patients (112 +/- 17%) was not significantly different from the other groups. The septic pancreatitis group had the largest percentage (82%) of hypermetabolic (resting energy expenditure greater than 110% of predicted energy expenditure) patients, whereas 61% and 33% of the acute and chronic pancreatitis groups were hypermetabolic, respectively (p less than .02). CONCLUSIONS: Resting energy expenditure is variable in patients with pancreatitis (77% to 139% of predicted energy expenditure). The Harris-Benedict equations are an unreliable estimate of caloric expenditure. Septic complications are associated with hypermetabolism and may be the most important factor influencing resting energy expenditure in pancreatitis patients.

Acute Disease↗
PubMed1994

Continuous measurement of energy expenditure in ventilated burn patients: an analysis.

OBJECTIVE: To predict the daily total energy expenditure of ventilated burn patients, this study was designed to determine the contribution of different activities on energy expenditure over a 24-hr period. DESIGN: Cohort study. SETTING: Burn unit of an adult hospital. PATIENTS: Twenty clinically stable burn patients undergoing mechanical ventilation with 36.7 +/- 4.2 total % burn surface area. INTERVENTIONS: Patients were fed according to a previously validated equation which takes into account the Harris-Benedict equation, % burn surface area, caloric intake, body temperature, and the number of postburn days: Toronto Formula = -4343 + (10.5 x % burn surface area) + (0.23 x caloric intake) + (0.84 x Harris-Benedict equation) + (114 x body temperature) - (4.5 x postburn days). The total energy expenditure of patients was measured by indirect calorimetry and their activity levels were recorded over a 24-hr period. RESULTS: The calculated Toronto Formula was 2191 +/- 83 kcal/day and patients were fed 2276 +/- 40 kcal/day. The measured resting energy expenditure was 2149 +/- 102 kcal/day and was similar to the Toronto Formula (NS). The total energy expenditure was 2492 +/- 120 kcal/day. Altogether the activities contributed 27.3 +/- 1.3% to the total energy expenditure and did not correlate with the % burn surface area. The activity factor calculated as [total energy expenditure less resting energy expenditure] x 100/resting energy expenditure was 16.6 +/- 2.4% and calculated as [total energy expenditure less Toronto Formula]/Toronto Formula was 14.5 +/- 4.3%. CONCLUSIONS: These results suggest that in clinically stable, mechanically ventilated burn patients, the Toronto Formula accurately predicts the resting energy expenditure and that the Toronto Formula or the resting energy expenditure x 1.2 can be used to estimate the total daily energy requirements.

Activities of Daily Living↗
PubMed2000

Energy expenditure in 100 ventilated, critically ill children: improving the accuracy of predictive equations.

OBJECTIVE: The purpose of this study was to evaluate current methods of predicting energy requirements and to develop and validate new equations derived from energy expenditure measurements of ventilated, critically ill children. DESIGN: Prospective, observational, sequential study. SETTING: Pediatric intensive care unit. PATIENTS: A total of 100 ventilated, critically ill children who fit the criteria of energy expenditure measurement. Additional patients (n = 25) were included in the validation study. INTERVENTION: An indirect calorimeter was used to measure energy expenditure for a period of 30 mins. MEASUREMENTS AND MAIN RESULTS: The mean measured energy expenditure was 185+/-51 kJ/kg per day. Predicted energy expenditure from standard equations was compared with measured energy expenditure by using the Bland and Altman "methods comparison procedure," and poor precision and accuracy were observed. Patient variables were collected at the time of measurement, and multiple regression analysis was performed to determine the independent contribution of each variable to measure energy expenditure. New predictive equations were formulated and validated with additional energy expenditure measurements. Patient variables that did not correlate significantly with energy expenditure were gender, Pediatric Risk of Mortality score, and commencement of nutritional support. An equation was derived from patient variables (age, weight, weight for age Z score, body temperature, number of days after intensive care admission, and primary reason for admission) that correlated significantly (r2 = .898) with measured energy expenditure. A second, simplified equation (energy expenditure kJ/day = ¿17 x age [months]¿ + ¿48 x weight [kg]¿ + ¿292 x body temperature degrees C¿ - 9,677) was produced (r2 = .867). Validation found no significant difference between measured and predicted energy expenditure by the new equations; however, the equations did not predict accurately for patients <2 months of age. CONCLUSION: The new equations provide a more accurate alternative to current predictive methods in assessing energy requirements of ventilated, critically ill children.

Calorimetry, Indirect↗
PubMed1997

Free-living daily energy expenditure in patients with Parkinson's disease.

Previous studies have suggested that elevated resting energy expenditure contributes to weight loss in patients with Parkinson's disease (PD). Body weight is, however, ultimately determined by variation in daily energy expenditure and not just resting energy expenditure. Therefore, we examined the hypothesis that PD patients are characterized by elevated daily energy expenditure. Sixteen patients with levodopa responsive PD and 46 healthy elderly controls were characterized for daily energy expenditure and its components (resting and physical activity energy expenditure) using a combination of the doubly labeled water technique (over 10 days) and resting indirect calorimetry. Fat-free mass and fat mass were measured by dual energy x-ray absorptiometry. Results showed that fat mass and fat-free mass did not differ between groups. Daily energy expenditure was 15% lower (2214 +/- 460 vs. 2590 +/- 497 kcal/d; p < 0.01) in PD patients compared to controls. This was primarily due to lower physical activity energy expenditure (339 +/- 366 vs. 769 +/- 412 kcal/d; P < 0.01) in PD patients as resting energy expenditure was not different between groups (1655 +/- 283 vs. 1561 +/- 219 kcal/d). These results show that daily energy expenditure is lower in PD patients compared to healthy elderly, primarily due to reduced physical activity energy expenditure. These results argue against the hypothesis that an abnormally elevated daily energy expenditure contributes to weight loss in PD.

Aged↗
PubMed2000

Regulatory factors of medical care expenditures for older people in Japan--analysis based on secondary medical care areas in Hokkaido.

For the purpose of clarifying determinants of medical care expenditure for older people in Japan, we analyzed the data on medical care expenditure for older people in 21 secondary medical care areas in Hokkaido, the second largest island of Japan. The annual amount of medical expenditure per insured older person can be reduced into three components: annual number of medical care bills per insured older person days of hospitalization or visits per medical care bill and amount of medical expenditure per day and per insured older person. The 21 secondary medical care areas in Hokkaido showed large differences in per capita amount of both inpatient and outpatient medical expenditures for older people. Per capita inpatient medical expenditure for men and women correlated positively with the days of hospitalization per bill and the per capita number of inpatient medical care bills per year, but inversely with the per capita amount of expenditure per day of hospitalization. The same held true for outpatient medical expenditure for men, but for women outpatient medical expenditure correlated positively with all three components. Multiple regression analysis indicated the more powerful effects of medical care demand or supply on inpatient medical expenditure, on the other hand, not much powerful effects of every index were indicated on outpatient medical expenditure.

Aged↗
PubMed2006

Distribution of health care expenditures for HIV-infected patients.

BACKGROUND: Health care expenditures for persons infected with human immunodeficiency virus (HIV) in the United State determined on the basis of actual health care use have not been reported in the era of highly active antiretroviral therapy. METHODS: Patients receiving primary care at the University of Alabama at Birmingham HIV clinic were included in the study. All encounters (except emergency room visits) that occurred within the University of Alabama at Birmingham Hospital System from 1 March 2000 to 1 March 2001 were analyzed. Medication expenditures were determined on the basis of 2001 average wholesale price. Hospitalization expenditures were determined on the basis of 2001 Medicare diagnostic related group reimbursement rates. Clinic expenditures were determined on the basis of 2001 Medicare current procedural terminology reimbursement rates. RESULTS: Among the 635 patients, total annual expenditures for patients with CD4+ cell counts <50 cells/microL (36,533 dollars per patient) were 2.6-times greater than total annual expenditures for patients with CD4+ cell counts > or =350 cells/microL (13,885 dollars per patient), primarily because of increased expenditures for nonantiretroviral medication and hospitalization. Expenditures for highly active antiretroviral therapy were relatively constant at approximately 10,500 dollars per patient per year across CD4+ cell count strata. Outpatient expenditures were 1558 dollars per patient per year; however, the clinic and physician component of these expenditures represented only 359 dollars per patient per year, or 2% of annual expenses. Health care expenditures for patients with HIV infection increased substantially for those with more-advanced disease and were driven predominantly by medication costs (which accounted for 71%-84% of annual expenses). CONCLUSIONS: Physician reimbursements, even with 100% billing and collections, are inadequate to support the activities of most clinics providing HIV care. These findings have important implications for the continued support of HIV treatment programs in the United States.

Adolescent↗
PubMed1991

Have hospital inpatient cost containment programs contributed to the growth in outpatient expenditures? Analysis of the substitution effect associated with hospital utilization review.

The rapid increase in outpatient expenditures has been the focus of growing attention in recent years. This increase has corresponded with public and private efforts to contain hospital inpatient costs, prompting some analysts to suggest that outpatient expenditure growth is the result of a substitution effect; that is, the substitution of outpatient for inpatient care associated with hospital cost containment programs. Claims data on 43 privately insured groups that adopted utilization review (UR) during the latter part of 1984 or early 1985 were analyzed, comparing outpatient expenditures before and after adoption of hospital inpatient UR to quantify the substitution effect associated with UR. UR was not associated with higher physician office expenditures nor with higher outpatient diagnostic expenditures. UR was related to significantly higher hospital outpatient department expenditures. On average, these expenditures were approximately 20% higher (P = 0.01) after the adoption of UR. However, outpatient department expenditures of the groups analyzed represented a fairly small percentage of total medical expenditures; hence, the absolute expenditure increase was quite modest, on the order of $9 per insured person per year. This analysis, admittedly limited in scope, suggests that UR is associated with a measurable substitution effect. It is likely that inpatient hospital cost containment programs have resulted in some substitution of outpatient for inpatient care and thus have played a role in fostering outpatient expenditure growth during recent years.

Cost Control↗