Ozieh Mukoso N, Dismuke Clara E, Lynch Cheryl P, Egede Leonard E
Medical University of South Carolina, Division of Nephrology, Charleston, SC. USA; Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, SC, USA.
Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, SC, USA; Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA.
Diabetes Res Clin Pract. 2015 Jul;109(1):185-90. doi: 10.1016/j.diabres.2015.04.011. Epub 2015 Apr 20.
Approximately 1 in 3 adults with diabetes have CKD. However, there are no recent national estimates of the association of CKD with medical care expenditures in individuals with diabetes. Our aim is to assess the association of CKD with total medical expenditures in US adults with diabetes using a national sample and novel cost estimation methodology.
Data on 2,053 adults with diabetes in the 2011 Medical Expenditure Panel Survey (MEPS) was analyzed. Individuals with CKD were identified based on self-report. Adjusted mean health services expenditures per person in 2011 were estimated using a two-part model after adjusting for demographic and clinical covariates.
Of the 2,053 individuals with diabetes, approximately 9.7% had self-reported CKD. Unadjusted mean expenditures for individuals with CKD were $20,726 relative to $9,689.49 for no CKD. Adjusted mean expenditures from the 2-part model for individuals with CKD were $8473 higher relative to individuals without CKD. Additional significant covariates were Hispanic/other race, uninsured, urban dwellers, CVD, stroke, high cholesterol, arthritis, and asthma. The estimated unadjusted total expenditures for individuals with CKD were estimated to be in excess of $43 billion in 2011.
We showed that CKD is a significant contributor to the financial burden among individuals with diabetes, and that minorities and the uninsured with CKD may experience barriers in access to care. Our study also provides a baseline national estimate of CKD cost in Diabetes by which future studies can be used for comparison.
约三分之一的成年糖尿病患者患有慢性肾脏病（CKD）。然而，目前尚无关于CKD与糖尿病患者医疗费用关联的最新全国性评估。我们的目的是使用全国样本和新颖的成本估算方法，评估美国成年糖尿病患者中CKD与总医疗费用之间的关联。
分析了2011年医疗支出面板调查（MEPS）中2053名成年糖尿病患者的数据。根据自我报告确定患有CKD的个体。在调整了人口统计学和临床协变量后，使用两部分模型估计了2011年每人调整后的平均医疗服务支出。
在2053名糖尿病患者中，约9.7%自我报告患有CKD。患有CKD的个体未经调整的平均支出为20,726美元，而未患CKD的个体为9,689.49美元。两部分模型中患有CKD的个体调整后的平均支出比未患CKD的个体高出8473美元。其他显著的协变量包括西班牙裔/其他种族、未参保、城市居民、心血管疾病（CVD）、中风、高胆固醇、关节炎和哮喘。2011年，患有CKD的个体估计未经调整的总支出超过430亿美元。
我们表明，CKD是糖尿病患者经济负担的重要因素，并且患有CKD的少数族裔和未参保者在获得医疗服务方面可能面临障碍。我们的研究还提供了糖尿病中CKD成本的全国性基线估计，未来的研究可据此进行比较。
