先前存在的慢性疾病在与工作相关的肌肉骨骼损伤后对医疗支出的年龄差异有多大贡献？

How much do preexisting chronic conditions contribute to age differences in health care expenditures after a work-related musculoskeletal injury?

机构信息

*School of Public Health and Preventive Medicine, The Alfred Centre, Monash University, Melbourne, Vic., Australia †Institute for Work & Health ‡Dalla Lana School of Public Health, University of Toronto §Mobility Program Clinical Research Unit, St. Michael's Hospital ∥Department of Occupational Sciences and Occupational Therapy, University of Toronto, Toronto, ON, Canada.

出版信息

Med Care. 2014 Jan;52(1):71-7. doi: 10.1097/MLR.0000000000000017.

DOI:10.1097/MLR.0000000000000017

PMID:24220682

Abstract

OBJECTIVES

To estimate the contribution of preexisting chronic conditions on age differences in health care expenditures for the management of work-related musculoskeletal injuries in British Columbia.

METHODS

A secondary analysis of workers' compensation claims submitted over the 5-year period between January 1, 2002 and December 31, 2006 (N = 55,827 claims among men and 32,141 claims among women). Path models examined the relationships between age and health care expenditures, and the extent to which age differences in health care expenditures were mediated by preexisting chronic conditions. Models were adjusted for individual, injury, occupational, and industrial covariates.

RESULTS

The relationship between age and health care expenditures differed for men and women, with a stronger age gradient observed among men. Preexisting osteoarthritis and coronary heart disease were associated with elevated health care expenditures among men and women. Diabetes was associated with elevated health care expenditures among men only, and depression was associated with elevated health care expenditures among women only. The percentage of the age effect on health care expenditures that was mediated through preexisting chronic conditions increased from 12.4% among 25-34-year-old men (compared with 15-24 y) to 26.6% among 55+-year-old men; and 14.6% among 25-34-year-old women to 35.9% among women 55 and older.

CONCLUSIONS

The results of this study demonstrate that differences in preexisting chronic conditions have an impact on the relationship between older age and greater health care expenditures after a work-related musculoskeletal injury. The differing prevalence of preexisting osteoarthritis, coronary heart disease, and to a lesser extent diabetes (among men) and depression (among women) across age groups explain a nontrivial proportion of the age effect in health care expenditures after injury. However, approximately two thirds or more of the age effect in health care expenditures remains unexplained.

摘要

目的

估计不列颠哥伦比亚省与工作相关的肌肉骨骼损伤管理中，预先存在的慢性疾病对年龄差异导致的医疗保健支出的影响。

方法

这是对工人赔偿索赔进行的二次分析，分析数据来自 2002 年 1 月 1 日至 2006 年 12 月 31 日的 5 年期间（男性 55827 项索赔，女性 32141 项索赔）。路径模型检验了年龄与医疗保健支出之间的关系，以及预先存在的慢性疾病在多大程度上对医疗保健支出的年龄差异产生中介作用。模型调整了个体、损伤、职业和工业因素的影响。

结果

年龄与医疗保健支出之间的关系在男性和女性之间有所不同，在男性中观察到更强的年龄梯度。预先存在的骨关节炎和冠心病与男性和女性的医疗保健支出增加有关。糖尿病仅与男性的医疗保健支出增加有关，而抑郁症仅与女性的医疗保健支出增加有关。预先存在的慢性疾病对年龄对医疗保健支出的影响的中介比例从 25-34 岁男性（与 15-24 岁相比）的 12.4%增加到 55 岁以上男性的 26.6%；以及 25-34 岁女性的 14.6%增加到 55 岁以上女性的 35.9%。

结论

这项研究的结果表明，预先存在的慢性疾病的差异对与工作相关的肌肉骨骼损伤后年龄较大和医疗保健支出较高之间的关系有影响。在不同年龄组中，预先存在的骨关节炎、冠心病以及在较小程度上糖尿病（男性）和抑郁症（女性）的患病率不同，这解释了受伤后医疗保健支出年龄效应的相当大一部分。然而，医疗保健支出的年龄效应仍有大约三分之二或更多无法解释。