The impact of race and ethnicity on healthcare utilization, medication utilization, and obesity-related clinical measurements in an employee-based insured population
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Objective: To evaluate an association between race/ethnicity on healthcare and medication utilization, as well as obesity-related clinical measures across weight categories in patients who are overweight or obese within an employee-based commercial insurance plan. Methods: This retrospective cohort study used administrative claims and electronic health record data from an integrated delivery network in Texas. Patients that were 18 years or older at index, BMI ≥ 25 or greater at index, had continuous health plan enrollment throughout the study period, and did not die during the study period were included in the study. Patients were divided into 4 race/ethnicity groups and categorized by obesity classification. The primary outcome of this analysis was healthcare utilization as measured by inpatient, outpatient, and emergency department visits. Kruskal-Wallis tests and chi-square tests were employed to analyze overall differences in continuous and categorical data, respectively. Results: Among 6,051 patients, 4,384 patients were White, 892 were Black, 439 were Hispanic or Latino, and 336 were categorized as Other. Additionally, 2,386 patients were overweight at index, followed by 1,914 obese class I patients, 928 obese class II patients, and 823 obese class III patients. The composite outcome of outpatient visits, inpatient visits, and emergency department visits were significantly different across race/ethnicity groups for all patients (p<0.0001) and obesity classifications including overweight (p=0.002), obese class I (p<0.0001), and obese class II (p=0.0087). Within obese class III, there were no significant differences in race for outpatient visits (p=0.6757), presence of at least one emergency department visit (p=0.3104), and composite outcome of all visits (p=0.5274). Conclusion: Despite patients being on an employee-based commercial insurance plan with continued coverage, differences in healthcare utilization, medication utilization, obesity-related clinical measures, and bariatric surgery utilization were present. However, patients with class III obesity demonstrated no significant differences in healthcare utilization, medication utilization, and frequency of clinical measures among race categories. These results suggest that worsening obesity severity is associated with increased healthcare utilization of patients despite racial or ethnic classification, providing real-world evidence for the management of overweight and obese patients, especially in relation to racial and ethnic minorities who are low utilizers of weight loss therapies.
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