Plant Based Diet, Lifestyle, and Medical Cost - A Matched Cohort Study

Background: Plant based diet and lifestyle have been shown to reduce many chronic non-communicable diseases, which now accounts for major global burden of diseases. We tried to determine the contribution of a plant based diet and lifestyle to actual direct medical cost in a population-based study. Methods: Through linkage to the National Health Insurance Database of Taiwan, we compared health care utilization and medical expenditure of 2166 vegetarians and 4332 age, sex matched non-vegetarians recruited from the Buddhist Tzu Chi Foundation. Diet and lifestyle questionnaires were self-administered and prospectively collected. General linear model was used to estimate the 5-year average medical cost in vegetarians versus non-vegetarians 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 activities and religious emotional support) were estimated by comparing with published population medical cost data standardized to match the age and sex characteristics of the cohort. Findings: Tzu Chi vegetarians have significant lower outpatient visits, inpatient admissions. This translates to 13% lower outpatient (P=0·007) and 15% total medical expenditure (P=0·008) compared with Tzu Chi non-vegetarians, who have additionally 8% lower medical expenditure compared with the general population. No difference in dental visits and expenses were found between diet groups. Interpretation: Plant based diet and healthy lifestyle are associated with significantly lower medical care utilization and expenditure and should be the first choice of strategies to alleviate the current medical-economic burden. Funding: This work was supported by a grant from the Department of Health in Taiwan (grant number: DOH94-TD-F-113-044) for cohort establishment, and by grants (grant numbers: TCMMPSP104-08-02, TCMMP105-13-05, TCMMP106-04-01) from the Buddhist Tzu Chi Medical Foundation for cohort follow-ups and linkage to the National Health Insurance Database. Declaration of Interest: None. Ethical Approval: The study was approved by the Institutional Reviewer Board at the Dalin Tzu Chi Hospital and signed informed consents were obtained from all study participants.