Vicky Copley, PHE Risk Factor Intelligence How Obesity Affects the Need for Social Care: Preliminary Findings from HSE Vicky Copley, PHE Risk Factor Intelligence

Outline Background Data Methods Results Summary of work so far Future considerations How obesity affects the need for social care

PHE Adult Weight Management Tool Version 1 launched April 2014 Designed to help the public health community make informed decisions about the commissioning of obesity interventions by providing a practical assessment of costs and benefits. Uses population-level data to estimate the health impact of weight loss in any group of people who have participated in an intervention or programme. Designed to be used to compare the costs and benefits of interventions for which there are outcome data, as well as to test theoretical or planned programmes where data are absent. Developed with an expert advisory group and tested with practitioners Available to download from http://www.noo.org.uk/visualisation/economic_assessment_tool How obesity affects the need for social care

Simple model of obesity and health Impact on mortality and disease: diabetes heart disease stroke colorectal cancer breast cancer Study population BMI healthcare costs How obesity affects the need for social care

Modified by an intervention How obesity affects the need for social care

Feedback Post-launch feedback mainly minor technical issues Some more fundamental challenges (“why aren’t any of my programmes cost-effective?”) Survey conducted in October 2014 Wants: Young people Clearer assumptions Social care costs How obesity affects the need for social care

Possible approaches to social care costs Published estimates of social care costs By BMI By disease category Estimate our own Health Survey for England (HSE) How obesity affects the need for social care

Data Health Survey for England (HSE) Has included social care questions for people aged 65 and over since 2011 Pooled three years of data 2011-2013 HSE does not cover care homes Obtains self-reported need for, and receipt of, social care Activities of Daily Living (ADLs) Instrumental Activities of Daily Living (IADLs) Height and weight measured during interviewer visit Other variables which may have independent association with need for social care Limiting long term illness Age Sex Ethnicity Deprivation etc. How obesity affects the need for social care

ADLs and IADLs ADLs relate to personal care and mobility about the home, while IADLs are additional activities which are important to living independently How obesity affects the need for social care

Sources of help Formal Informal Home care worker* Spouse / partner 2nd homecare worker* 3rd homecare worker* Reablement team* Occupational therapist/physiotherapist Voluntary helper Warden/sheltered housing manager* Cleaner Council handyman* * denotes potential LA-funded help Informal Spouse / partner Family member Friend etc How obesity affects the need for social care

Some descriptive statistics Unweighted count % or mean % of those with self-reported need for social care (95% CI) Body mass index (kg/m2)   <18.5 52 0.8 0.8 (0.3 to 1.3) 18-25 1328 20.8 13.8 (11.9 to 15.7) 25-30 2152 33.2 19.5 (17.5 to 21.5) 30-40 1405 21.7 21.3 (19.1 to 23.5) 40+ 108 1.7 2.5 (1.7 to 3.3) Missing and unreliable 1417 21.8 42.1 (39.4 to 44.9) Limiting long term illness No 3632 55.7 12.2 (10.4 to 13.9) Yes 2830 44.3 87.8 (86.1 to 89.6) Sex Female 3500 45.3 62.9 (60.9 to 65.0) Male 2962 54.7 37.1 (35.0 to 39.1) Age (years) 65-69 2004 30.4 16.9 (14.9 to 18.8) 70-74 1609 24.3 18.3 (16.3 to 20.3) 75-79 1262 20.0 19.5 (17.4 to 21.7) 80-84 904 14.4 21.5 (19.4 to 23.6) 85+ 683 11.0 23.8 (21.5 to 26.1) IMD quintile 1 least deprived 1474 22.6 15.4 (13.2 to 17.6) 2 1592 24.9 22.4 (20.0 to 24.9) 3 21.9 21.4 (19.1 to 23.8) 4 1105 17.1 20.8 (18.5 to 23.2) 5 most deprived 886 13.4 19.9 (17.4 to 22.4) Some descriptive statistics How obesity affects the need for social care

Method Two-step approach model the probability of self-reported need for social care univariable regression multivariable regression with adjustment for all potential determinants excluding limiting long term illness multivariable regression with adjustment for all potential determinants including limiting long term illness combine model-predicted probability of need for social care with the mean hours of help received -> calculate the expected hours of help received per adult The numbers reporting a need for help with social care in the HSE are higher than those who report that they received help with care. This demonstrates indicates an unmet need for help and indicates suggests that the determinants of the need for social care are different to the determinants of the hours of help actually received. With this approach our estimates of expected hours of social care received assume that there is no unmet need for social care, i.e. that care is being provided if there is a need, and that the reported hours provided are adequate to meet that need. How obesity affects the need for social care

Results 6462 observations of adults aged 65 or over available for analysis Considered missing values as separate category in categorical variables Imputed missing height and weight and used continuous BMI in multivariable regression models Conditional on receiving at least some help, the mean hours of care received per week, per person is 20.9 hours from informal sources 1.6 from formal local authority sources 22.4 hours in total after coding of missing values and imputation of missing height and weight. How obesity affects the need for social care

Results from multivariable models Marginal predicted probabilities of self-reported need for help with ADL and IADL, by BMI. Dotted lines represent 95% confidence intervals. Model 2 is adjusted for limiting long-term illness, in addition to the sociodemographic factors considered in model 1. How obesity affects the need for social care

Expected hours of care by BMI after coding of missing values and imputation of missing height and weight. Expected hours of community-based care per week, per person by source of care and BMI in population aged 65 and over How obesity affects the need for social care

Add in cost The expected hours of help received can be combined with the average hourly cost of a social care worker to provide estimates of the cost of social care by BMI for use in economic models. The total cost of providing a home care worker in England is approximately £24 per hour and on this basis, using model 2, the annual cost of local authority funded social care for an individual with a BMI of 40 kg/m2 would be £653 (£24*52 weeks*0.52 hours per week). The same cost for an individual with a BMI of 18 kg/m2 is £354. For a local authority with 30,000 adults aged over 65 with a morbid obesity prevalence of 2.1% this equates to an annual excess social care cost of £188,000. Corresponding annual costs estimated using model 1 are £948 and £415 for BMIs of 40 and 18 respectively, equivalent to an annual excess social care cost to the local authority of £336,000. after coding of missing values and imputation of missing height and weight. How obesity affects the need for social care

Summary Social care costs make up an important part of the overall cost to society of obesity There is a paucity of robust UK data on the association between BMI and social care usage Our approach uses a transparent methodological approach combined with Health Survey for England data to provide an estimate of community-based social care costs associated with obesity in the over 65s Adjusted for other factors which affect social care need Estimates will be incorporated into the PHE cost effectiveness tool This is a first attempt at estimating these costs… Quite conservative Only over 65s Non-care home population after coding of missing values and imputation of missing height and weight. How obesity affects the need for social care

To consider Is definition of formal care appropriate e.g. should occupational therapists be included in definition Other sources of data care home population population aged under 65 Model might consider wider cost to society Total hours of care rather than LA-funded care Does all care received reflect need? How obesity affects the need for social care