University of Maryland School of Nursing, Baltimore, MD, USA.
South Carolina College of Pharmacy, University of South Carolina, Greenville, SC, USA.
Value Health. 2014 Jan-Feb;17(1):51-61. doi: 10.1016/j.jval.2013.11.008.
To compare population-level baseline characteristics, individual-level utilization, and costs between antihypertensive medication users versus nonusers in adults with diabetes and concomitant hypertension.
This longitudinal retrospective observational research used Medical Expenditure Panel Survey household component pooled years 2006 to 2009 to analyze adults 18 years or older with nongestational diabetes and coexistent essential hypertension. Two groups were created: 1) antihypertensive medication users and 2) no antihypertensive pharmacotherapy. We examined average annualized health care costs and emergency department and hospital utilization. Accounting for Medical Expenditure Panel Survey's complex survey design, all analyses used longitudinal weights. Logistic regressions examined the likelihood of utilization and anytihypertensive medication use, and log-transformed multiple linear regression models assessed costs and antihypertensive medication use.
Of the 3261 adults identified with diabetes, 66% (n = 2137) had concomitant hypertension representing 38.7 million individuals during 2006 to 2009. Significantly, the 16% (n = 338) no antihypertensive pharmacotherapy group showed greater mean nights hospitalized (3.6 vs. 1.7, P = 0.0120), greater all-cause hospitalization events per 1000 patient months (41 vs. 24, P = 0.0.007), and lower mean diabetes-related and hypertension-related ambulatory visits. After adjusting for confounders, non-antihypertensive medication users showed 1.64 odds of hospitalization, 29% lower total, and 27% lower average annualized medical expenses compared with antihypertensive medication users.
In adults with diabetes and coexistent hypertension, we observed significantly greater hospitalizations and lower costs for the non antihypertensive pharmacotherapy group versus those using antihypertensive medications. The short-term time horizon greater hospitalizations with lower expenses among non-antihypertensive medication users with diabetes and concomitant hypertension warrant further study.
比较患有糖尿病和并发高血压的成年人中，降压药物使用者与非使用者在人群基线特征、个体利用情况和成本方面的差异。
本纵向回顾性观察性研究使用医疗支出面板调查家庭组成部分 2006 年至 2009 年的汇总数据，分析年龄在 18 岁或以上、无妊娠糖尿病且并发原发性高血压的成年人。创建了两组：1）降压药物使用者和 2）无降压药物治疗。我们检查了平均年化医疗保健费用以及急诊室和医院的利用情况。考虑到医疗支出面板调查的复杂调查设计，所有分析均使用纵向权重。逻辑回归检验了利用和使用任何抗高血压药物的可能性，对数转换的多元线性回归模型评估了成本和抗高血压药物的使用。
在确定的 3261 名患有糖尿病的成年人中，66%（n=2137）患有并发高血压，代表 2006 年至 2009 年期间的 3870 万人。值得注意的是，16%（n=338）无降压药物治疗组的平均住院夜数更多（3.6 比 1.7，P=0.0120），每 1000 个患者月的全因住院事件更多（41 比 24，P=0.007），而糖尿病相关和高血压相关的门诊就诊次数更少。在调整混杂因素后，与降压药物使用者相比，非降压药物使用者的住院可能性高 1.64 倍，总费用低 29%，平均年化医疗费用低 27%。
在患有糖尿病和并发高血压的成年人中，我们观察到非降压药物治疗组的住院次数显著增加，而费用降低。与使用降压药物的患者相比，非降压药物使用者在短期内住院次数增加，而费用降低，这一现象值得进一步研究。
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