The Economic and Clinical Burden of Pediatric Obesity Within a Universal Health Coverage System in Thailand: A 9-Year Nationwide Analysis of 14.5 Million Hospitalizations.

BACKGROUND

While pediatric obesity prevalence is rising, the association between ICD-coded obesity, healthcare resource utilization, and inpatient outcomes in middle-income countries remains poorly quantified. This study examined inpatient diagnostic patterns, resource utilization, and in-hospital mortality among hospitalized pediatric patients with ICD-coded obesity in Thailand's Universal Coverage scheme during a 9-year period.

METHODS

We analyzed nationwide inpatient administrative data from January 2015 to December 2023 for children aged 1 month to <18 years. ICD-coded obesity was defined using ICD-10-TM codes recorded as either a principal diagnosis or a comorbidity. Outcomes included length of stay, hospital costs, and in-hospital mortality. Univariable and multivariable regression models were used to estimate associations between ICD-coded obesity and inpatient outcomes, with adjustment for age, sex, region, hospital level, admission year, and disease categories.

RESULTS

Among 14,483,566 hospitalized children, 42,168 had ICD-coded obesity. Notably, 95.7% of children with ICD-coded obesity were recorded as a comorbidity rather than the primary reason for admission. Children with ICD-coded obesity as a comorbidity had 156.8% higher median hospital costs. Across all major categories of common acute diseases (respiratory, intestinal, digestive), children with ICD-coded obesity had significantly higher median costs and longer length of stay compared to children without ICD-coded obesity. In regression analyses, ICD-coded obesity remained associated with longer length of stay (adjusted ratio, 1.21; 95% CI, 1.16-1.26; p < 0.001) and higher hospitalization cost (adjusted cost ratio, 1.42; 95% CI, 1.32-1.53; p < 0.001). The association with in-hospital mortality was observed in the unadjusted model but was attenuated after adjustment and was not statistically significant (adjusted odds ratio, 1.14; 95% CI, 0.89-1.45; p = 0.303).

CONCLUSIONS

In Thailand's national universal coverage scheme, ICD-coded obesity was associated with greater inpatient resource utilization, especially longer length of stay and higher hospitalization costs. These findings support the need for weight-aware inpatient management and adjusted funding models for hospitals treating this higher-resource-utilization subgroup.