Chinthammit Chanadda, Coull Bruce M, Nimworapan Mantiwee, Bhattacharjee Sandipan
Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, Arizona.
Neurology Department, College of Medicine, The University of Arizona, Tucson, Arizona.
J Stroke Cerebrovasc Dis. 2017 Feb;26(2):393-402. doi: 10.1016/j.jstrokecerebrovasdis.2016.09.040. Epub 2016 Oct 25.
This study examined the impact of co-occurring chronic conditions on healthcare expenditures among noninstitutionalized older adults (age ≥50 years) with stroke in comparison to non-stroke-matched controls.
This study used a retrospective, cross-sectional, matched case-control design using pooled 2002-2012 Medical Expenditure Panel Survey (MEPS) data. Stroke survivors (N = 2913) were compared with matched controls (N = 8739) based on propensity scores. Healthcare expenditures for co-occurring chronic conditions were compared between stroke survivors and matched controls using ordinary least squares (OLS) regressions. All analyses were conducted in SAS 9.4 (SAS Institute Inc., Cary, NC, USA) using survey procedures adjusting for the complex survey design of the MEPS.
The annual mean total healthcare expenditures (expressed in 2012 United States dollars) were significantly higher among stroke survivors compared with matched non-stroke controls ($18,796 versus $14,391, P < .001). OLS regressions revealed that co-occurring chronic conditions partially explained the excess healthcare expenditures among stroke survivors. The annual mean total healthcare expenditures among stroke survivors were significantly higher for most of the co-occurring chronic conditions compared with matched controls (e.g., in presence of hyperlipidemia, stroke survivor expenditures were $18,807 compared to $15,807 among matched controls). Stroke survivors with co-occurring arthritis, diabetes, or hypertension had significantly greater inpatient, emergency room, and prescription expenditures compared with matched controls.
Stroke survivors experience a high economic burden. Interdisciplinary team-based treatment approaches to provide holistic care may help reduce the burden due to co-occurring chronic medical conditions among stroke survivors.
本研究调查了与非卒中匹配对照组相比，并存慢性病对非机构化老年卒中患者（年龄≥50岁）医疗费用的影响。
本研究采用回顾性、横断面、匹配病例对照设计，使用2002 - 2012年医疗支出面板调查（MEPS）汇总数据。基于倾向得分将卒中幸存者（N = 2913）与匹配对照组（N = 8739）进行比较。使用普通最小二乘法（OLS）回归比较卒中幸存者与匹配对照组并存慢性病的医疗费用。所有分析均在美国北卡罗来纳州卡里市SAS研究所的SAS 9.4软件中进行，采用调查程序对MEPS的复杂调查设计进行调整。
与匹配的非卒中对照组相比，卒中幸存者的年平均总医疗费用（以2012年美元表示）显著更高（18,796美元对14,391美元，P <.001）。OLS回归显示，并存慢性病部分解释了卒中幸存者额外的医疗费用。与匹配对照组相比，大多数并存慢性病的卒中幸存者年平均总医疗费用显著更高（例如，存在高脂血症时，卒中幸存者的费用为18,807美元，而匹配对照组为15,807美元）。与匹配对照组相比，并存关节炎、糖尿病或高血压的卒中幸存者的住院、急诊室和处方费用显著更高。
卒中幸存者承受着高昂的经济负担。基于跨学科团队的治疗方法提供整体护理可能有助于减轻卒中幸存者并存慢性疾病带来的负担。
