Mendelian Randomization analysis of the causal effect of adiposity on hospital costs
Open accessAbstract
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.
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Effects of harmful exposures become less evident with increasing age because of selection bias due to the almost inevitable selection only of survivors.
“Although, it is very important to bear in mind that effects of harmful exposures become less evident with increasing age because of selection bias due to the almost inevitable selection only of survivors.145”
From Mendelian randomization (2022) · cites this paper as [145]
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Cited by
Sorted by citations
Sanderson, E., Glymour, M. M., Holmes, M. V., Kang, H., Morrison, J., Munafò, M. R., Palmer, T., Schooling, C. M., Wallace, C., Zhao, Q., et al. (2022) · Nature Reviews Methods Primers · doi:10.1038/s43586-021-00092-5 · Cited by 2,229 · see citing works
- Authors
- Dixon, P., Hollingworth, W., Harrison, S., Davies, N. M., & Davey Smith, G.
- Affiliations
- University of Bristol (GB)
- Corresponding author
- Dixon, Padraig
- Venue
- Journal of Health Economics
- Publisher
- Elsevier BV
- Published
- 2020-03
- Volume
- 70
- Pages
- 102300
- ISSN
- 0167-6296 (ISSN-L)
- PMC
- PMC7188219
- OpenAlex
- W2996367824
- Cited by
- 48
- References
- 141
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 11 · 2023: 9 · 2022: 10 · 2021: 10 · 2020: 1 · 2019: 1
- FWCI
- 4.39
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Health Economics (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (publishedVersion, cc-by)
- Explore Bristol Research (acceptedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- Medical Research Council (MR/P014259/1, MC_UU_12013/1, MC_UU_12013/9)
- University of Bristol
- Economic and Social Research Council (ES/N000757/1)
- Health Foundation
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic Associations and Epidemiology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- adiposity, body mass index, hospital costs, causal effects, endogeneity bias, instrumental variables, Mendelian randomization, inverse variance weighting
- MeSH terms
- Adult, Aged, Female, United Kingdom, Humans, Male, Middle Aged, Body Mass Index, Databases, Factual, Hospital Costs, Adiposity, Mendelian Randomization Analysis
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