The Rise in Pediatric Obesity-Related Conditions and Costs in Public Insurance Programs: Evidence from Alabama

Background: The increase in pediatric obesity rates is well documented. The extent of corresponding increases in diagnoses of obesity-related conditions (Ob-Cs) and associated medical costs for children in public insurance programs is unknown. Methods: Retrospective claims data linked to enrollees' demographic data for Alabama's Children's Health Insurance Program (ALL Kids) 1999–2015 were used. Multivariate linear probability models were used to estimate the likelihood of having any Ob-C diagnoses. Two-part models for inpatient, outpatient, emergency department (ED), and overall costs were estimated. Results: The proportion of enrollees with Ob-C diagnoses almost doubled from 1.3% to 2.5%. The likelihood of diagnoses increased over time (0.0994 percentage points per year, p < 0.001). Statistically higher rates of increase were seen for minority and lowest-income enrollees and for those getting preventive well visits. Costs for those with Ob-Cs increased relative to those without over time, particularly inpatient and outpatient costs. Conclusions: Prevalence of Ob-C diagnoses and costs have increased substantially. This may partly be because of underdiagnoses/underreporting in the past. However, evidence suggests that underdiagnoses are still a major issue.