Associations Between Undernutrition and Healthcare Utilization and Costs in Community-Dwelling Adults: A Longitudinal Observational Study
Author(s)
Ge Lixia, MPH, MSc, Chun Wei Yap, PhD.
Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore.
Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore.
OBJECTIVES: The impact of undernutrition on healthcare utilisation and costs is underexplored in Asian populations. This study examined the longitudinal association between undernutrition and healthcare use across various settings among community-dwelling adults in Singapore.
METHODS: We analysed data from 1,703 participants in the Population Health Index study who consented to data linkage. Nutritional status was assessed annually using the Mini Nutritional Assessment and classified as undernourished if total score <24 (out of 30) or screening score <12 (out of 14). One-year and five-year healthcare utilisation and cost data were extracted from a centralised institutional repository, spanning five settings: primary care, specialist outpatient clinics (SOCs), emergency departments (EDs), day surgeries (DSs), and inpatient admissions. Two-part Hurdle models (logistic regression for any use; negative binomial or generalised linear models for intensity/cost) assessed associations with undernutrition, adjusting for baseline covariates.
RESULTS: Undernutrition was associated with higher odds of SOC visits (odds ratio [OR]: 1.66, 95% confidence interval [CI]: 1.03, 2.68), ED visits (OR: 1.85, 95% CI: 1.18, 2.92), and inpatient admissions (OR: 2.47, 95% CI: 1.42, 4.29) in one year, and with admissions in five years (OR: 1.62 , 95% CI: 1.07, 2.47). Among users, undernutrition was not linked to greater utilisation or costs in one year. Over five years, it was associated with fewer visits (Incidence Rate Ratio [IRR]: 0.75, 95% CI: 0.61, 0.94) and lower expenditure in primary care settings (β: -0.33, 95% CI: -0.58, -0.09), lower expenditure in SOCs (β: -0.41, 95% CI: -0.73, -0.09) but more admissions (IRR: 1.31, 95% CI: 1.04, 1.64), and higher ED costs (β: 0.27, 95% CI: 0.02, 0.53).
CONCLUSIONS: Undernutrition is independently associated with increased emergency and inpatient utilisation over time. Early detection and intervention may reduce preventable, high-cost healthcare utilisation, especially in ageing populations.
METHODS: We analysed data from 1,703 participants in the Population Health Index study who consented to data linkage. Nutritional status was assessed annually using the Mini Nutritional Assessment and classified as undernourished if total score <24 (out of 30) or screening score <12 (out of 14). One-year and five-year healthcare utilisation and cost data were extracted from a centralised institutional repository, spanning five settings: primary care, specialist outpatient clinics (SOCs), emergency departments (EDs), day surgeries (DSs), and inpatient admissions. Two-part Hurdle models (logistic regression for any use; negative binomial or generalised linear models for intensity/cost) assessed associations with undernutrition, adjusting for baseline covariates.
RESULTS: Undernutrition was associated with higher odds of SOC visits (odds ratio [OR]: 1.66, 95% confidence interval [CI]: 1.03, 2.68), ED visits (OR: 1.85, 95% CI: 1.18, 2.92), and inpatient admissions (OR: 2.47, 95% CI: 1.42, 4.29) in one year, and with admissions in five years (OR: 1.62 , 95% CI: 1.07, 2.47). Among users, undernutrition was not linked to greater utilisation or costs in one year. Over five years, it was associated with fewer visits (Incidence Rate Ratio [IRR]: 0.75, 95% CI: 0.61, 0.94) and lower expenditure in primary care settings (β: -0.33, 95% CI: -0.58, -0.09), lower expenditure in SOCs (β: -0.41, 95% CI: -0.73, -0.09) but more admissions (IRR: 1.31, 95% CI: 1.04, 1.64), and higher ED costs (β: 0.27, 95% CI: 0.02, 0.53).
CONCLUSIONS: Undernutrition is independently associated with increased emergency and inpatient utilisation over time. Early detection and intervention may reduce preventable, high-cost healthcare utilisation, especially in ageing populations.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
P33
Topic
Clinical Outcomes, Epidemiology & Public Health, Methodological & Statistical Research
Topic Subcategory
Public Health
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Nutrition