How do type 2 diabetes mellitus (T2DM)-related complications and socioeconomic factors impact direct medical costs? A cross-sectional study in rural Southeast China

ObjectiveTo evaluate type 2 diabetes mellitus (T2DM)-related direct medical costs by complication type and complication number, and to assess the impacts of complications as well as socioeconomic factors on direct medical costs.DesignA cross-sectional study using data from the region’s diabetes mana...

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Published in:	BMJ open Vol. 8; no. 11; p. e020647
Main Authors:	Wu, Haibin, Eggleston, Karen N, Zhong, Jieming, Hu, Ruying, Wang, Chunmei, Xie, Kaixu, Chen, Yiwei, Chen, Xiangyu, Yu, Min
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group LTD 01.11.2018 BMJ Publishing Group
Subjects:	Adult Aged Aging China - epidemiology Cost of Illness Costs Cross-Sectional Studies Diabetes Diabetes Complications - economics Diabetes Complications - epidemiology Diabetes Mellitus, Type 2 - economics Diabetes Mellitus, Type 2 - epidemiology Diabetic nephropathy Epidemiology Female GDP Gross Domestic Product Health care expenditures Health Economics Health Expenditures - statistics & numerical data Humans Insurance - classification Insurance - statistics & numerical data Insurance claims Male Middle Aged Older people Primary care Public health Registries Socioeconomic Factors China epidemiology general diabetes health economics
ISSN:	2044-6055, 2044-6055
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Abstract	ObjectiveTo evaluate type 2 diabetes mellitus (T2DM)-related direct medical costs by complication type and complication number, and to assess the impacts of complications as well as socioeconomic factors on direct medical costs.DesignA cross-sectional study using data from the region’s diabetes management system, social security system and death registry system, 2015.SettingTongxiang, China.ParticipantsIndividuals diagnosed with T2DM in the local diabetes management system, and who had 2015 insurance claims in the social security system. Patients younger than 35 years and patients whose insurance type changed in the year 2015 were excluded.Main outcome measuresThe mean of direct medical costs by complication type and number, and the percentage increase of direct medical costs relative to a reference group, considering complications and socioeconomic factors.ResultsA total of 19 015 eligible individuals were identified. The total cost of patients with one complication was US$1399 at mean, compared with US$248 for patients without complications. The mean total cost for patients with 2 and 3+ complications was US$1705 and US$2994, respectively. After adjustment for socioeconomic confounders, patients with one complication had, respectively, 83.55% and 38.46% greater total costs for inpatient and outpatient services than did patients without complications. The presence of multiple complications was associated with a significant 44.55% adjusted increase in total outpatient costs, when compared with one complication. Acute complications, diabetic foot, stroke, ischaemic heart disease and diabetic nephropathy were the highest cost complications. Gender, age, education level, insurance type, T2DM duration and mortality were significantly associated with increased expenditures of T2DM.ConclusionsComplications significantly aggravated expenditures on T2DM. Specific kinds of complications and the presence of multiple complications are correlated with much higher expenditures. Proper management and the prevention of related complications are urgently needed to reduce the growing economic burden of diabetes.
AbstractList	ObjectiveTo evaluate type 2 diabetes mellitus (T2DM)-related direct medical costs by complication type and complication number, and to assess the impacts of complications as well as socioeconomic factors on direct medical costs.DesignA cross-sectional study using data from the region’s diabetes management system, social security system and death registry system, 2015.SettingTongxiang, China.ParticipantsIndividuals diagnosed with T2DM in the local diabetes management system, and who had 2015 insurance claims in the social security system. Patients younger than 35 years and patients whose insurance type changed in the year 2015 were excluded.Main outcome measuresThe mean of direct medical costs by complication type and number, and the percentage increase of direct medical costs relative to a reference group, considering complications and socioeconomic factors.ResultsA total of 19 015 eligible individuals were identified. The total cost of patients with one complication was US$1399 at mean, compared with US$248 for patients without complications. The mean total cost for patients with 2 and 3+ complications was US$1705 and US$2994, respectively. After adjustment for socioeconomic confounders, patients with one complication had, respectively, 83.55% and 38.46% greater total costs for inpatient and outpatient services than did patients without complications. The presence of multiple complications was associated with a significant 44.55% adjusted increase in total outpatient costs, when compared with one complication. Acute complications, diabetic foot, stroke, ischaemic heart disease and diabetic nephropathy were the highest cost complications. Gender, age, education level, insurance type, T2DM duration and mortality were significantly associated with increased expenditures of T2DM.ConclusionsComplications significantly aggravated expenditures on T2DM. Specific kinds of complications and the presence of multiple complications are correlated with much higher expenditures. Proper management and the prevention of related complications are urgently needed to reduce the growing economic burden of diabetes. To evaluate type 2 diabetes mellitus (T2DM)-related direct medical costs by complication type and complication number, and to assess the impacts of complications as well as socioeconomic factors on direct medical costs.OBJECTIVETo evaluate type 2 diabetes mellitus (T2DM)-related direct medical costs by complication type and complication number, and to assess the impacts of complications as well as socioeconomic factors on direct medical costs.A cross-sectional study using data from the region's diabetes management system, social security system and death registry system, 2015.DESIGNA cross-sectional study using data from the region's diabetes management system, social security system and death registry system, 2015.Tongxiang, China.SETTINGTongxiang, China.Individuals diagnosed with T2DM in the local diabetes management system, and who had 2015 insurance claims in the social security system. Patients younger than 35 years and patients whose insurance type changed in the year 2015 were excluded.PARTICIPANTSIndividuals diagnosed with T2DM in the local diabetes management system, and who had 2015 insurance claims in the social security system. Patients younger than 35 years and patients whose insurance type changed in the year 2015 were excluded.The mean of direct medical costs by complication type and number, and the percentage increase of direct medical costs relative to a reference group, considering complications and socioeconomic factors.MAIN OUTCOME MEASURESThe mean of direct medical costs by complication type and number, and the percentage increase of direct medical costs relative to a reference group, considering complications and socioeconomic factors.A total of 19 015 eligible individuals were identified. The total cost of patients with one complication was US$1399 at mean, compared with US$248 for patients without complications. The mean total cost for patients with 2 and 3+ complications was US$1705 and US$2994, respectively. After adjustment for socioeconomic confounders, patients with one complication had, respectively, 83.55% and 38.46% greater total costs for inpatient and outpatient services than did patients without complications. The presence of multiple complications was associated with a significant 44.55% adjusted increase in total outpatient costs, when compared with one complication. Acute complications, diabetic foot, stroke, ischaemic heart disease and diabetic nephropathy were the highest cost complications. Gender, age, education level, insurance type, T2DM duration and mortality were significantly associated with increased expenditures of T2DM.RESULTSA total of 19 015 eligible individuals were identified. The total cost of patients with one complication was US$1399 at mean, compared with US$248 for patients without complications. The mean total cost for patients with 2 and 3+ complications was US$1705 and US$2994, respectively. After adjustment for socioeconomic confounders, patients with one complication had, respectively, 83.55% and 38.46% greater total costs for inpatient and outpatient services than did patients without complications. The presence of multiple complications was associated with a significant 44.55% adjusted increase in total outpatient costs, when compared with one complication. Acute complications, diabetic foot, stroke, ischaemic heart disease and diabetic nephropathy were the highest cost complications. Gender, age, education level, insurance type, T2DM duration and mortality were significantly associated with increased expenditures of T2DM.Complications significantly aggravated expenditures on T2DM. Specific kinds of complications and the presence of multiple complications are correlated with much higher expenditures. Proper management and the prevention of related complications are urgently needed to reduce the growing economic burden of diabetes.CONCLUSIONSComplications significantly aggravated expenditures on T2DM. Specific kinds of complications and the presence of multiple complications are correlated with much higher expenditures. Proper management and the prevention of related complications are urgently needed to reduce the growing economic burden of diabetes. To evaluate type 2 diabetes mellitus (T2DM)-related direct medical costs by complication type and complication number, and to assess the impacts of complications as well as socioeconomic factors on direct medical costs. A cross-sectional study using data from the region's diabetes management system, social security system and death registry system, 2015. Tongxiang, China. Individuals diagnosed with T2DM in the local diabetes management system, and who had 2015 insurance claims in the social security system. Patients younger than 35 years and patients whose insurance type changed in the year 2015 were excluded. The mean of direct medical costs by complication type and number, and the percentage increase of direct medical costs relative to a reference group, considering complications and socioeconomic factors. A total of 19 015 eligible individuals were identified. The total cost of patients with one complication was US$1399 at mean, compared with US$248 for patients without complications. The mean total cost for patients with 2 and 3+ complications was US$1705 and US$2994, respectively. After adjustment for socioeconomic confounders, patients with one complication had, respectively, 83.55% and 38.46% greater total costs for inpatient and outpatient services than did patients without complications. The presence of multiple complications was associated with a significant 44.55% adjusted increase in total outpatient costs, when compared with one complication. Acute complications, diabetic foot, stroke, ischaemic heart disease and diabetic nephropathy were the highest cost complications. Gender, age, education level, insurance type, T2DM duration and mortality were significantly associated with increased expenditures of T2DM. Complications significantly aggravated expenditures on T2DM. Specific kinds of complications and the presence of multiple complications are correlated with much higher expenditures. Proper management and the prevention of related complications are urgently needed to reduce the growing economic burden of diabetes.
Author	Chen, Xiangyu Wang, Chunmei Wu, Haibin Eggleston, Karen N Xie, Kaixu Zhong, Jieming Hu, Ruying Chen, Yiwei Yu, Min
AuthorAffiliation	3 Tongxiang Center for Disease Control and Prevention , Jiaxing , China 2 Shorenstein Asia-Pacific Research Center , Stanford University , Stanford , California , USA 4 Department of Economics , Stanford University , Stanford , California , USA 1 Department of NCDs Control and Prevention , Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , China
AuthorAffiliation_xml	– name: 3 Tongxiang Center for Disease Control and Prevention , Jiaxing , China – name: 4 Department of Economics , Stanford University , Stanford , California , USA – name: 1 Department of NCDs Control and Prevention , Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , China – name: 2 Shorenstein Asia-Pacific Research Center , Stanford University , Stanford , California , USA
Author_xml	– sequence: 1 givenname: Haibin surname: Wu fullname: Wu, Haibin email: minyu_cdc@126.com organization: Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China – sequence: 2 givenname: Karen N surname: Eggleston fullname: Eggleston, Karen N email: minyu_cdc@126.com organization: Shorenstein Asia-Pacific Research Center, Stanford University, Stanford, California, USA – sequence: 3 givenname: Jieming surname: Zhong fullname: Zhong, Jieming email: minyu_cdc@126.com organization: Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China – sequence: 4 givenname: Ruying surname: Hu fullname: Hu, Ruying email: minyu_cdc@126.com organization: Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China – sequence: 5 givenname: Chunmei surname: Wang fullname: Wang, Chunmei email: minyu_cdc@126.com organization: Tongxiang Center for Disease Control and Prevention, Jiaxing, China – sequence: 6 givenname: Kaixu surname: Xie fullname: Xie, Kaixu email: minyu_cdc@126.com organization: Tongxiang Center for Disease Control and Prevention, Jiaxing, China – sequence: 7 givenname: Yiwei surname: Chen fullname: Chen, Yiwei email: minyu_cdc@126.com organization: Department of Economics, Stanford University, Stanford, California, USA – sequence: 8 givenname: Xiangyu surname: Chen fullname: Chen, Xiangyu email: minyu_cdc@126.com organization: Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China – sequence: 9 givenname: Min surname: Yu fullname: Yu, Min email: minyu_cdc@126.com organization: Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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Snippet	ObjectiveTo evaluate type 2 diabetes mellitus (T2DM)-related direct medical costs by complication type and complication number, and to assess the impacts of... To evaluate type 2 diabetes mellitus (T2DM)-related direct medical costs by complication type and complication number, and to assess the impacts of...
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SubjectTerms	Adult Aged Aging China - epidemiology Cost of Illness Costs Cross-Sectional Studies Diabetes Diabetes Complications - economics Diabetes Complications - epidemiology Diabetes Mellitus, Type 2 - economics Diabetes Mellitus, Type 2 - epidemiology Diabetic nephropathy Epidemiology Female GDP Gross Domestic Product Health care expenditures Health Economics Health Expenditures - statistics & numerical data Humans Insurance - classification Insurance - statistics & numerical data Insurance claims Male Middle Aged Older people Primary care Public health Registries Socioeconomic Factors
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Title	How do type 2 diabetes mellitus (T2DM)-related complications and socioeconomic factors impact direct medical costs? A cross-sectional study in rural Southeast China
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