Variations in Obesity Prevalence and Association with Facility Characteristics: Evidence from New York State

Objectives: With the aging of the population and the growing obesity epidemic among Americans, the proportion of obese nursing home residents has increased 66% since 1992. Yet, little is known about the characteristics of facilities that serve obese residents. In this study we identified facility characteristics associated with risk-adjusted obesity prevalence.

Study Design: We employed the Minimum Data Set for NYS, linking it with the Nursing Home Compare and the Online Survey, Certification, and Reporting databases for CY2005-07. We focused on two facility-level outcome variables: rates of risk-adjusted obesity (BMI&ge30) and morbid obesity (BMI&ge40). Facility characteristics included: financial resources, resident case-mix and staffing, and quality of care. Individual-level factors were used to calculate risk-adjusted obesity rates. Multivariate regression models with facility-fixed-effects were employed.

Findings: Facilities with higher level of financial resources exhibited higher obesity rate. Each 1% increase in the proportion of Medicare residents was related to 12% increase in obesity prevalence. Higher case-mix was negatively related, while higher staffing was positively related to obesity rate. Each 1% increase in the proportion of residents with moderate-to-severe cognitive impairment was associated with lower obesity (23%) and morbid obesity rates (37%). Every 0.1 increase in the staffing ratio was related to higher obesity (6%) and morbid obesity rates (15%). Facilities with poorer quality had higher obesity/morbid obesity rates. Each additional quality of care deficiency was associated with higher obesity (1.6%) and morbid obesity rates (2%).

Conclusions: Resource availability and quality of care indicators were associated with risk-adjusted obesity and morbid obesity rates.