Kaiser Permanente Center for Health Research, Portland, Oregon, USA.
Am J Cardiol. 2011 Jan 15;107(2):225-9. doi: 10.1016/j.amjcard.2010.09.010.
Hypertriglyceridemia is a lipid abnormality prevalent in 1/3 of the United States adult population. Our objective was to describe the independent contribution of hypertriglyceridemia to medical care costs. Using an observational cohort of 108,324 members of Kaiser Permanente Northwest, we analyzed the electronic medical records of those patients aged ≥18 years who had triglyceride (TG) measurements in 2008 and had been members of Kaiser Permanente Northwest for the entire year. After assigning patients to TG categories of <150, 150 to 199, 200 to 499, and ≥500 mg/dl, we compared the annual direct medical costs. To isolate the independent contribution of the TG levels, we adjusted the costs for age, gender, body mass index, blood pressure, smoking history, low-density lipoprotein and high-density lipoprotein cholesterol, and health conditions such as cardiovascular disease, diabetes, and renal disease. Of the 108,324 study subjects, 64.1% had normal TG levels (<150 mg/dl), 16.4% had borderline high levels (150 to 199 mg/dl), 18.0% had high TG levels (200 to 499 mg/dl), and 1.5% had very high TG levels (≥500 mg/dl). After adjustment, the patients with TG levels ≥500 mg/dl (severe hypertriglyceridemia) had significantly greater mean total costs ($8,567, 99% confidence interval $7,034 to $10,100) than those with levels <150 mg/dl ($6,186, 99% confidence interval $6,058 to $6,314), 150 to 199 mg/dl ($6,449, 99% confidence interval $6,196 to $6,702), or 200 to 499 mg/dl ($6,376, 99% confidence interval $6,118 to $6,634). The differences were driven by both outpatient and pharmaceutical costs. The inpatient costs were also greater for those with TG levels ≥500 mg/dl, but the difference did not reach statistical significance. In conclusion, severe hypertriglyceridemia was associated with 33% to 38% greater medical costs per annum, independent of resource-intensive conditions such as cardiovascular disease, heart failure, hypertension, and diabetes.
高甘油三酯血症是美国成年人中普遍存在的一种脂质异常，约占成年人的三分之一。我们的目的是描述高甘油三酯血症对医疗费用的独立贡献。我们利用 Kaiser Permanente Northwest 的 108324 名成员的观察性队列，分析了在 2008 年进行甘油三酯（TG）检测且全年均为 Kaiser Permanente Northwest 成员的年龄≥18 岁患者的电子病历。将患者分为 TG 水平<150、150 至 199、200 至 499 和≥500mg/dl 组后，我们比较了每年的直接医疗费用。为了分离 TG 水平的独立贡献，我们根据年龄、性别、体重指数、血压、吸烟史、低密度脂蛋白和高密度脂蛋白胆固醇以及心血管疾病、糖尿病和肾脏疾病等健康状况调整了成本。在 108324 名研究对象中，64.1%的患者 TG 水平正常（<150mg/dl），16.4%的患者 TG 水平处于边缘升高（150 至 199mg/dl），18.0%的患者 TG 水平升高（200 至 499mg/dl），1.5%的患者 TG 水平极高（≥500mg/dl）。调整后，TG 水平≥500mg/dl（严重高甘油三酯血症）的患者的平均总费用（$8567，99%置信区间为$7034 至$10100）明显高于 TG 水平<150mg/dl（$6186，99%置信区间为$6058 至$6314）、150 至 199mg/dl（$6449，99%置信区间为$6196 至$6702）和 200 至 499mg/dl（$6376，99%置信区间为$6118 至$6634）。这种差异是由门诊和药物治疗费用驱动的。TG 水平≥500mg/dl 的患者的住院费用也更高，但差异无统计学意义。总之，严重高甘油三酯血症与每年 33%至 38%的医疗费用增加有关，独立于心血管疾病、心力衰竭、高血压和糖尿病等资源密集型疾病。
