How Obesity Affects the Need for Social Care: Preliminary Findings from HSE

Vicky Copley, PHE Risk Factor Intelligence

Outline• Background

• Data

• Methods

• Results

• Summary of work so far

• Future considerations

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PHE Adult Weight Management Tool• Version 1 launched April 2014

• Designed to help the public health community make informed decisions about the commissioning of obesity interventions by providing a practical assessment of costs and benefits.

• Uses population-level data to estimate the health impact of weight loss in any group of people who have participated in an intervention or programme.

• Designed to be used to compare the costs and benefits of interventions for which there are outcome data, as well as to test theoretical or planned programmes where data are absent.

• Developed with an expert advisory group and tested with practitioners

• Available to download from http://www.noo.org.uk/visualisation/economic_assessment_tool

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Simple model of obesity and health

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Study population

Study population BMIBMI

Impact on mortality and disease:

•diabetes•heart disease•stroke•colorectal cancer•breast cancer

Impact on mortality and disease:

•diabetes•heart disease•stroke•colorectal cancer•breast cancer

healthcare costshealthcare costs

Modified by an intervention

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Feedback• Post-launch feedback mainly minor technical issues

• Some more fundamental challenges (“why aren’t any of my programmes cost-effective?”)

• Survey conducted in October 2014

• Wants: • Young people

• Clearer assumptions

• Social care costs

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Possible approaches to social care costs• Published estimates of social care costs

• By BMI

• By disease category

• Estimate our own• Health Survey for England (HSE)

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Data• Health Survey for England (HSE)

• Has included social care questions for people aged 65 and over since 2011• Pooled three years of data 2011-2013

• HSE does not cover care homes

• Obtains self-reported need for, and receipt of, social care • Activities of Daily Living (ADLs)

• Instrumental Activities of Daily Living (IADLs)

• Height and weight measured during interviewer visit

• Other variables which may have independent association with need for social care

• Limiting long term illness

• Age

• Sex

• Ethnicity

• Deprivation

• etc.

• etc. 8 How obesity affects the need for social care

ADLs and IADLs

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Sources of help• Informal

• Spouse / partner

• Family member

• Friend

• etc

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• Formal• Home care worker*

• 2nd homecare worker*

• 3rd homecare worker*

• Reablement team*

• Occupational therapist/physiotherapist

• Voluntary helper

• Warden/sheltered housing manager*

• Cleaner

• Council handyman*

* denotes potential LA-funded help

Some descriptive statistics

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Unweighted count

% or mean

% of those with self-reported need for social care (95% CI)

Body mass index (kg/m2)     <18.5 52 0.8 0.8 (0.3 to 1.3) 18-25 1328 20.8 13.8 (11.9 to 15.7) 25-30 2152 33.2 19.5 (17.5 to 21.5) 30-40 1405 21.7 21.3 (19.1 to 23.5) 40+ 108 1.7 2.5 (1.7 to 3.3) Missing and unreliable 1417 21.8 42.1 (39.4 to 44.9)Limiting long term illness       No 3632 55.7 12.2 (10.4 to 13.9) Yes 2830 44.3 87.8 (86.1 to 89.6)Sex       Female 3500 45.3 62.9 (60.9 to 65.0) Male 2962 54.7 37.1 (35.0 to 39.1)Age (years)       65-69 2004 30.4 16.9 (14.9 to 18.8) 70-74 1609 24.3 18.3 (16.3 to 20.3) 75-79 1262 20.0 19.5 (17.4 to 21.7) 80-84 904 14.4 21.5 (19.4 to 23.6) 85+ 683 11.0 23.8 (21.5 to 26.1)IMD quintile       1 least deprived 1474 22.6 15.4 (13.2 to 17.6) 2 1592 24.9 22.4 (20.0 to 24.9) 3 1405 21.9 21.4 (19.1 to 23.8) 4 1105 17.1 20.8 (18.5 to 23.2) 5 most deprived 886 13.4 19.9 (17.4 to 22.4)

Method• Two-step approach

1. model the probability of self-reported need for social care

• univariable regression• multivariable regression with adjustment for all potential determinants excluding

limiting long term illness• multivariable regression with adjustment for all potential determinants including

limiting long term illness

2. combine model-predicted probability of need for social care with the mean hours of help received-> calculate the expected hours of help received per adult

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Results• 6462 observations of adults aged 65 or over available for analysis

• Considered missing values as separate category in categorical variables

• Imputed missing height and weight and used continuous BMI in multivariable regression models

• Conditional on receiving at least some help, the mean hours of care received per week, per person is • 20.9 hours from informal sources

• 1.6 from formal local authority sources

• 22.4 hours in total

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Results from multivariable models

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Expected hours of care by BMI

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Expected hours of community-based care per week, per person by source of care and BMI in population aged 65 and over

Add in costThe expected hours of help received can be combined with the average hourly

cost of a social care worker to provide estimates of the cost of social care by BMI for use in economic models.

The total cost of providing a home care worker in England is approximately £24 per hour and on this basis, using model 2, the annual cost of local authority funded social care for an individual with a BMI of 40 kg/m2 would be £653 (£24*52 weeks*0.52 hours per week).

The same cost for an individual with a BMI of 18 kg/m2 is £354.

For a local authority with 30,000 adults aged over 65 with a morbid obesity prevalence of 2.1% this equates to an annual excess social care cost of £188,000.

Corresponding annual costs estimated using model 1 are £948 and £415 for BMIs of 40 and 18 respectively, equivalent to an annual excess social care cost to the local authority of £336,000.

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Summary• Social care costs make up an important part of the overall cost to society of

obesity

• There is a paucity of robust UK data on the association between BMI and social care usage

• Our approach uses a transparent methodological approach combined with Health Survey for England data to provide an estimate of community-based social care costs associated with obesity in the over 65s• Adjusted for other factors which affect social care need

• Estimates will be incorporated into the PHE cost effectiveness tool

• This is a first attempt at estimating these costs…• Quite conservative

• Only over 65s• Non-care home population

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To consider• Is definition of formal care appropriate

• e.g. should occupational therapists be included in definition

• Other sources of data• care home population

• population aged under 65

• Model might consider wider cost to society• Total hours of care rather than LA-funded care

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