Boudreau D M, Malone D C, Raebel M A, Fishman P A, Nichols G A, Feldstein A C, Boscoe A N, Ben-Joseph R H, Magid D J, Okamoto L J
Group Health, Center for Health Studies, Seattle, Washington, USA.
Metab Syndr Relat Disord. 2009 Aug;7(4):305-14. doi: 10.1089/met.2008.0070.
This study compared prevalent health utilization and costs for persons with and without metabolic syndrome and investigated the independent associations of the various factors that make up metabolic syndrome.
Subjects were enrollees of three health plans who had all clinical measurements (blood pressure, fasting plasma glucose, body mass index, triglycerides, and high-density lipoprotein cholesterol) necessary to determine metabolic syndrome risk factors over the 2-year study period (n = 170,648). We used clinical values, International Classification of Diseases, Ninth Revision (ICD-9) diagnoses, and medication dispensings to identify risk factors. We report unadjusted mean annual utilization and modeled mean annual costs adjusting for age, sex, and co-morbidity.
Subjects with metabolic syndrome (n = 98,091) had higher utilization and costs compared to subjects with no metabolic syndrome (n = 72,557) overall, and when stratified by diabetes (P < 0.001). Average annual total costs between subjects with metabolic syndrome versus no metabolic syndrome differed by a magnitude of 1.6 overall ($5,732 vs. $3,581), and a magnitude of 1.3 when stratified by diabetes (diabetes, $7,896 vs. $6,038; no diabetes, $4,476 vs. $3,422). Overall, total costs increased by an average of 24% per additional risk factor (P < 0.001). Costs and utilization differed by risk factor clusters, but the more prevalent clusters were not necessarily the most costly. Costs for subjects with diabetes plus weight risk, dyslipidemia, and hypertension were almost double the costs for subjects with prediabetes plus similar risk factors ($8,067 vs. $4,638).
Metabolic syndrome, number of risk factors, and specific combinations of risk factors are markers for high utilization and costs among patients receiving medical care. Diabetes and certain risk clusters are major drivers of utilization and costs.
本研究比较了患有和未患有代谢综合征的人群的健康服务利用情况和费用，并调查了构成代谢综合征的各种因素的独立关联。
研究对象为三个健康计划的参与者，他们在为期2年的研究期间（n = 170,648）进行了所有确定代谢综合征风险因素所需的临床测量（血压、空腹血糖、体重指数、甘油三酯和高密度脂蛋白胆固醇）。我们使用临床值、国际疾病分类第九版（ICD-9）诊断和药物配给来识别风险因素。我们报告了未经调整的年均服务利用情况以及根据年龄、性别和合并症进行调整后的年均费用模型。
总体而言，患有代谢综合征的受试者（n = 98,091）与未患有代谢综合征的受试者（n = 72,557）相比，服务利用情况和费用更高，按糖尿病分层时也是如此（P < 0.001）。患有代谢综合征与未患有代谢综合征的受试者之间的年均总费用总体相差1.6倍（5,732美元对3,581美元），按糖尿病分层时相差1.3倍（糖尿病患者，7,896美元对6,038美元；非糖尿病患者，4,476美元对3,422美元）。总体而言，每增加一个风险因素，总费用平均增加24%（P < 0.001）。费用和服务利用情况因风险因素簇而异，但较常见的簇不一定是费用最高的。患有糖尿病加体重风险、血脂异常和高血压的受试者费用几乎是患有糖尿病前期加类似风险因素的受试者费用的两倍（8,067美元对4,638美元）。
代谢综合征、风险因素数量以及风险因素的特定组合是接受医疗护理患者中高服务利用和高费用的标志。糖尿病和某些风险簇是服务利用和费用的主要驱动因素。
