The relative impact of underweight, overweight, smoking, and physical inactivity on health and associated costs in Indonesia: propensity score matching of a national sample

Background: Indonesia is in the midst of a rapid epidemiological transition with a significant ageing population and increasing exposure to risk factors for chronic conditions. This study examines the relative impacts of obesity, tobacco consumption, and physical inactivity, on non-communicable diseases multimorbidity, health service use, catastrophic health expenditure (CHE), and loss in employment productivity in Indonesia. Methods: Secondary analyses were conducted of cross-sectional data from adults aged 40 years (n=12,081) in the Indonesian Family Life Survey 2014/2015. We used propensity score matching to assess the associations between behavioural risk factors and health service use, CHE, employment productivity, and multimorbidity. Results: Being obese, overweight and a former tobacco user was associated with a higher number of chronic conditions and multimorbidity (p<0.05). Being a former tobacco user contributed to a higher number of outpatient and inpatient visits as well as CHE incidences and work absenteeism. Physical inactivity relatively increased the number of outpatient visits (30% increase, p<0.05) and work absenteeism (21% increase, P<0.06). Although being underweight was associated with an increased outpatient care utilisation (23% increase, p<0.05), being overweight was negatively associated with CHE incidences (50% decrease, p