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Mendelian Randomization analysis of the causal effect of adiposity on hospital costs

Author

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  • Dixon, Padraig
  • Hollingworth, William
  • Harrison, Sean
  • Davies, Neil M.
  • Davey Smith, George

Abstract

Estimates of the marginal effect of measures of adiposity such as body mass index (BMI) on healthcare costs are important for the formulation and evaluation of policies targeting adverse weight profiles. Most estimates of this association are affected by endogeneity bias. We use a novel identification strategy exploiting Mendelian Randomization – random germline genetic variation modelled using instrumental variables – to identify the causal effect of BMI on inpatient hospital costs. Using data on over 300,000 individuals, the effect size per person per marginal unit of BMI per year varied according to specification, including £21.22 (95% confidence interval (CI): £14.35-£28.07) for conventional inverse variance weighted models to £18.85 (95% CI: £9.05-£28.65) for penalized weighted median models. Effect sizes from Mendelian Randomization models were larger in most cases than non-instrumental variable multivariable adjusted estimates (£13.47, 95% CI: £12.51-£14.43). There was little evidence of non-linearity. Within-family estimates, intended to address dynastic biases, were imprecise.

Suggested Citation

  • Dixon, Padraig & Hollingworth, William & Harrison, Sean & Davies, Neil M. & Davey Smith, George, 2020. "Mendelian Randomization analysis of the causal effect of adiposity on hospital costs," Journal of Health Economics, Elsevier, vol. 70(C).
  • Handle: RePEc:eee:jhecon:v:70:y:2020:i:c:s0167629619304084
    DOI: 10.1016/j.jhealeco.2020.102300
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    Cited by:

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    2. Bozzi, Debra G. & Nicholas, Lauren Hersch, 2021. "A Causal Estimate of Long-Term Health Care Spending Attributable to Body Mass Index Among Adults," Economics & Human Biology, Elsevier, vol. 41(C).

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    More about this item

    Keywords

    BMI; Obesity; Instrumental variables; Healthcare costs; Mendelian Randomization;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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