Abstract
Vegetarian diets and lifestyle have been shown to reduce the risk of many chronic non-communicable diseases, which now accounts for the major global burden of diseases. We aimed to determine the contribution of vegetarian diets and lifestyle to the actual direct medical cost in a population-based study. Through linkage to the National Health Insurance Research Database of Taiwan, we compared the health care utilization and medical expenditure of 2166 vegetarians and 4332 age-sex-matched omnivores recruited from the Buddhist Tzu Chi Foundation. Diet and lifestyle questionnaires were self-administered and prospectively collected. We used the general linear model to estimate the 5-year average medical expenditure in vegetarians versus omnivores while adjusting for age, sex, education, exercise habits, smoking, and alcohol drinking. Medical expenses related to non-diet associated lifestyle factors (smoking, alcohol drinking, active community volunteering, and religious emotional support) were estimated through a comparison with the published population medical cost data standardized to match the age and sex characteristics of the cohort. Tzu Chi vegetarians had significantly lower outpatient visits. This translated into 13% lower outpatient (p = 0.007) and 15% lower total medical expenditures (p = 0.008) when compared with the Tzu Chi omnivores, who had an additional 10% lower medical expenditure when compared with the general population. No difference in dental visits and expenses were found between diet groups. Vegetarian diets are associated with significantly lower medical care expenditure and could be an effective strategy to alleviate the medical-economic burden in selected populations.
Generated Summary
This study, a matched cohort study based in Taiwan, investigated the relationship between vegetarian diets and medical expenditure. The research utilized data from the National Health Insurance Research Database of Taiwan, comparing health care utilization and medical expenditure of 2,166 vegetarians and 4,332 age-sex-matched omnivores recruited from the Buddhist Tzu Chi Foundation. The study design involved self-administered diet and lifestyle questionnaires and prospective data collection. The general linear model was employed to estimate the 5-year average medical expenditure, adjusting for factors such as age, sex, education, exercise habits, smoking, and alcohol drinking. Medical expenses related to non-diet-associated lifestyle factors were estimated through comparison with published population medical cost data, standardized to match the cohort’s characteristics.
Key Findings & Statistics
- Vegetarians exhibited a 15% lower total medical expenditure (p = 0.013) compared to omnivores.
- Outpatient medical expenditure was 13% lower in vegetarians (p = 0.012).
- Inpatient medical expenditure was 20% lower for vegetarians compared with omnivores.
- Adjusted analyses revealed a 17% savings in total medical expenditure for vegetarians.
- Vegetarians showed 15% lower outpatient expenditure when adjusted.
- The analysis showed no significant difference in dental service expenditure between diet groups.
- Vegetarians had an 18% lower outpatient expenditure compared to omnivores (p = 0.049) in the <50 years of age group.
- Vegetarians in the >50 years of age group, had a 26% savings in total medical expenditure.
- Vegetarians exhibited a 28% reduction in medical expenditure related to hypertension.
- A 31% reduction in medical expenditure related to dyslipidemia was noted in vegetarians.
- The study found a 48% reduction in expenditure for depression in vegetarians.
- A 22% reduction in medical expenditure for coronary heart disease was found in vegetarians, although this was not statistically significant.
- A substantial 84% reduction in renal disease expenditure was found, though it was also not statistically significant.
Other Important Findings
- Vegetarians were less likely to have an exercise habit compared to omnivores.
- Education levels and marital status were similar between vegetarians and omnivores.
- Few participants in both groups reported smoking or alcohol consumption.
- Vegetarians consumed soy products, fruits, vegetables, and nuts more frequently.
- The omnivore group had a 10% lower medical expenditure compared to the general population estimates.
- Vegetarian diet was associated with lower medical expenditure in several conditions, including hypertension, dyslipidemia, and depression.
- No significant differences were found in dental service expenditure.
Limitations Noted in the Document
- The study relied on self-reported data for physical activity and dietary habits, which might be subject to recall bias or social desirability bias.
- Dietary information was collected only at baseline, without considering potential changes over time, which could affect the observed associations.
- Healthcare-seeking behaviors, which could influence medical utilization and expenditure, might vary between health-conscious individuals and others.
- The study population consisted of devoted Buddhists, which may limit the generalizability of the findings to the broader population due to their unique lifestyle choices.
Conclusion
This study underscores the potential of a vegetarian diet to reduce healthcare costs. The results, demonstrating a 15% reduction in total medical expenditure and a 13% reduction in outpatient expenditure among vegetarians, align with other research highlighting the benefits of plant-based diets. The study also found that vegetarian diets were associated with lower expenditure for the treatment of conditions such as hypertension, dyslipidemia, and depression. The findings are particularly relevant considering the global shift towards lifestyle-related diseases. Vegetarian diets, characterized by increased consumption of fruits, vegetables, soy, and nuts, may be a key strategy. The reduction in medical expenditure is notable, with the vegetarian group showing a 25% cost reduction compared to the general population, suggesting the importance of dietary interventions in managing medical costs. The lower medical expenditure between participants of the religion-based cohort and the general population may be attributed to religious activities, though more research is needed.