BMI and Cause-Specific Hospital Admissions and Costs: The UK Biobank Cohort Study.

OBJECTIVE: To estimate the effect of BMI on cause-specific hospital admissions and costs in men and women is not well understood, and this study's aim is to address this. METHODS: For 451,320 men and women aged 40 years or older recruited into the UK Biobank, followed up for 6 years on average, this study estimated annual rates and costs (at 2016 UK prices) of hospital admissions, overall and by diagnostic category (using International Classification of Diseases, Tenth Revision chapters), in relation to BMI. RESULTS: Among those who were never smokers, a 2-kg/m2 higher BMI (above 20 kg/m2 ) was associated with a 6.2% (99% CI: 5.3% to 7.2%) higher admission rate and an 8.6% (99% CI: 7.3% to 10.0%) higher annual cost in men and with a 5.7% (99% CI: 4.9% to 6.6%) higher admission rate and an 8.4% (99% CI: 7.5% to 9.3%) higher annual cost in women. Higher BMI was associated with higher admission rates and costs for many types of health conditions, particularly for endocrine, skin, and musculoskeletal disorders in both men and women and for circulatory diseases in men. CONCLUSIONS: BMI beyond healthy weight is strongly associated with higher annual rates of hospital admission and higher costs in both men and women across a wide range of health conditions.

Evaluating the impact of optical coherence tomography in diabetic retinopathy screening for an Aboriginal population.

IMPORTANCE: Optical coherence tomography is used routinely in management of diabetic eye disease but has not been evaluated in Australian outreach settings for screening programmes. BACKGROUND: The study aims to evaluate the use of optical coherence tomography combined with a fundus camera compared with a fundus camera only in a telehealth diabetic retinopathy screening programme for Aboriginal Australians. DESIGN: Retrospective comparative study was used. PARTICIPANTS: The study included patients with diabetes at two Aboriginal Health Services. METHODS: An intervention group was studied in 2015 using a Topcon 3D optical coherence tomography-1 Maestro combined with optical coherence tomography/fundus camera. A control group was studied in 2014 using a DRS non-mydriatic fundus camera. Fundus photographs were emailed to trained retinal graders for review. Optical coherence tomography scans were graded by ophthalmologists via remote TeamViewer access. MAIN OUTCOME MEASURE: Referral rates to an eye health professional and the rate of inadequate photographs. RESULTS: Two hundred and twenty-two patients were included, with 80 in the control group and 142 in the intervention group. There was a significantly higher rate of inadequate fundus photographs in the intervention group (31.0% vs. 13.8%). Although there was a higher rate of referral to an eye health professional in the intervention group (39.6% vs. 30.0%), this was not significant. Diabetic retinopathy and maculopathy was evident in 32.3% and 12.0% of adequate fundus photographs, respectively. Diabetic macular oedema was present in 3.6% of optical coherence tomography scans. CONCLUSIONS AND RELEVANCE: The combined optical coherence tomography fundus camera provided no advantage for diabetic retinopathy screening compared with fundus photography in an Australian programme. The rate of referral to an eye health professional was not reduced with a higher rate of inadequate fundus photographs.