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

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

3. 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
How obesity affects the need for social care

4. 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

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

6. 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

7. 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

8. Data Health Survey for England (HSE)
Has included social care questions for people aged 65 and over since 2011
Pooled three years of data
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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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