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Lower Vegetable Variety and Worsening Diet Quality Over Time Are Associated With Higher 15-Year Health Care Claims and Costs Among Australian Women

Published:January 22, 2021DOI:https://doi.org/10.1016/j.jand.2020.12.012

      Abstract

      Background

      The relationship between diet quality and health care costs is unclear.

      Objective

      The aim of this study was to investigate the relationship between baseline diet quality and change in diet quality over time, with 15-year cumulative health care claims/costs.

      Design

      Data from a longitudinal cohort study were analyzed.

      Participants/setting

      Data for survey 3 (2001) (n = 7,868) and survey 7 (2013) (n = 6,349 both time points) from the 1946-1951 cohort of the Australian Longitudinal Study on Women’s Health were analyzed.

      Main outcome measures

      Diet quality was assessed using the Australian Recommended Food Score (ARFS). Fifteen-year cumulative Medicare Benefits Schedule (Australia’s universal health care coverage) data were reported by baseline ARFS quintile and category of diet quality change (“diet quality worsened” [ARFS change ≤ –4 points], “remained stable” [–3 ≤ change in ARFS ≤3 points], or “improved” [ARFS change ≥4 points]).

      Statistical analyses

      Linear regression analyses were conducted adjusting for area of residence, socioeconomic status, lifestyle factors, and private health insurance status.

      Results

      Consuming a greater variety of vegetables at baseline but fewer fruit and dairy products was associated with lower health care costs. For every 1-point increment in the ARFS vegetable subscale, women made 3.3 (95% CI, 1.6-5.0) fewer claims and incurred AU$227 (95% CI, AU$104-350 [US$158; 95% CI, US$72-243]) less in costs. Women whose diet quality worsened over time made more claims (median, 251 claims; quintile 1, quintile 3 [Q1; Q3], 168; 368 claims) and incurred higher costs (AU$15,519; Q1; Q3, AU$9,226; AU$24,847 [US$10,793; Q1; Q3, US$6,417; US$17,281]) compared with those whose diet quality remained stable (median, 236 claims [Q1; Q3, 158; 346 claims], AU$14,515; Q1; Q3, AU$8,539; AU$23,378 [US$10,095; Q1; Q3, US$5,939; US$16,259]).

      Conclusions

      Greater vegetable variety was associated with fewer health care claims and costs; however, this trend was not consistent across other subscales. Worsening diet quality over 12 years was linked with higher health care claims and costs.

      Keywords

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      Biography

      J. N. Baldwin is a casual academic, The University of Newcastle Faculty of Health and Medicine, Callaghan, NSW, Australia, and a senior statistician, The University of Newcastle Priority Research Centre for Physical Activity and Nutrition, Callaghan, NSW, Australia.

      Biography

      P. M. Forder is a senior statistician, The University of Newcastle Priority Research Centre for Generational Health and Ageing, New Lambton, New South Wales, Australia.

      Biography

      R. Haslam is a research associate, The University of Newcastle Faculty of Health and Medicine, Callaghan, NSW, Australia, and a senior statistician, The University of Newcastle Priority Research Centre for Physical Activity and Nutrition, Callaghan, NSW, Australia.

      Biography

      A. Hure is an associate professor, The University of Newcastle Priority Research Centre for Generational Health and Ageing, New Lambton, NSW, Australia, senior statistician, The University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia, and senior statistician, The University of Newcastle Hunter Medical Research Institute, New Lambton, NSW, Australia.

      Biography

      D. Loxton is a professor and deputy director, The University of Newcastle Priority Research Centre for Generational Health and Ageing, New Lambton, NSW, Australia.

      Biography

      A. J. Patterson is a senior lecturer, The University of Newcastle Faculty of Health and Medicine, Callaghan, NSW, Australia, and a senior statistician, The University of Newcastle Priority Research Centre for Physical Activity and Nutrition, Callaghan, NSW, Australia.

      Biography

      C. E. Collins is a professor and senior research fellow, The University of Newcastle Faculty of Health and Medicine, Callaghan, NSW, Australia, and a senior statistician, The University of Newcastle Priority Research Centre for Physical Activity and Nutrition, Callaghan, NSW, Australia.