The Association of Body Mass Index with Emergency Department Resource Utilization Open Access

Abstract

Background:

Obesity is a growing epidemic in the United States with increasing burden to the health care system [1]. The management of obesity poses challenges to Emergency Departments (ED) [2]. While resources are being directed to the chronic treatment and management of the overweight and obese, little is known about the impact of overweight on clinical decision making for adult acute care.

Methods:

Clinical encounter data were obtained from the Grady Memorial Hospital data warehouse, including consecutive adult ED visits from Oct 31, 2010 to Feb 28, 2015. Personal identifiers (name, medical record number, and encounter number) were replaced by randomly assigned arbitrary numbers, separately for encounter number and medical record number. Information was collected on various aspects including but not limited to patient’s age and sex, diagnoses, admission and disposition information, and weight and height. The outcome of interest was admission status, and the main exposure was body mass index (BMI), aggregated into 5 categories: underweight, normal, overweight, obese, and morbidly obese. Covariates chosen a priori included sex, age, ambulance arrival, triage acuity (using the Emergency Severity Index), and payer status. The study results were analyzed using SAS 9.4.

Results:

Participants categorized as underweight and morbidly obese had an increased risk of admission from the ED, after controlling for all covariates. The adjusted odds ratio for underweight was 2.012 (95% CI 1.914, 2.114) and for morbidly obese was 1.075 (95% CI 1.031, 1.121). There was significant interaction with sex and BMI, indicating obese or underweight males were more likely to be admitted as well. The adjusted odds ratio for underweight males was 2.12 (95% CI 2.03, 2.33) and for morbidly obese males was 1.37 (95% CI 1.28, 1.47). In contrast, the adjusted odds ratio for underweight females 1.82 (95% CI 1.69, 1.96) and morbidly obese females was 0.93 (95% CI 0.88, 0.98).

Conclusion:

Admission rates from the ED are higher for the lowest and highest BMI categories, and lowest for the overweight category, independent of sex, age, payer status, mode of arrival, and triage acuity. 

Table of Contents

A. Introduction: Background and Literature Review................................................2

B. Methods ................................................................................................5

C. Results..................................................................................................7

D. Discussion: Summary, Public Health Implications, and Possible Future Directions......10

E. References............................................................................................13

F. Tables.................................................................................................15

Table 1

Table 2

Table 3

Table 4

G. Figures and Figure Legends........................................................................18

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Figure 6 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Keyword	Admission Emergency Room BMI
Committee Chair / Thesis Advisor	Stephen R. Pitts, Emory University

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