成年糖尿病患者医疗保健支出中的性别差异：来自2002 - 2011年医疗支出面板调查的证据
Sex differences in healthcare expenditures among adults with diabetes: evidence from the medical expenditure panel survey, 2002-2011.
作者信息
Williams Joni S, Bishu Kinfe, Dismuke Clara E, Egede Leonard E
机构信息
Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
出版信息
BMC Health Serv Res. 2017 Apr 11;17(1):259. doi: 10.1186/s12913-017-2178-3.
BACKGROUND
The evidence assessing differences in medical costs between men and women with diabetes living in the United States is sparse; however, evidence suggests women generally have higher healthcare expenditures compared to men. Since little is known about these differences, the aim of this study was to assess differences in out-of-pocket (OOP) and total healthcare expenditures among adults with diabetes.
METHODS
Data were used from 20,442 adults (≥18 years of age) with diabetes from the 2002-2011 Medical Expenditure Panel Survey. Dependent variables were OOP and total direct expenditures for multiple health services (prescription, office-based, inpatient, outpatient, emergency, dental, home healthcare, and other services). The independent variable was sex. Covariates included sociodemographic characteristics, comorbid conditions, and time. Sample demographics were summarized. Mean OOP and total direct expenditures for health services by sex status were analyzed. Regression models were performed to assess incremental costs of healthcare expenditures by sex among adults with diabetes.
RESULTS
Fifty-six percent of the sample was composed of women. Unadjusted mean OOP costs were higher for women for prescriptions ($1177; 95% CI $1117-$1237 vs. $959; 95% CI $918-$1000; p < 0.001) compared to men. Unadjusted mean total direct expenditures were also higher for women for prescriptions ($3797; 95% CI $3660-$3934 vs. $3334; 95% CI $3208-$3460; p < 0.001) and home healthcare ($752; 95% CI $646-$858 vs. $397; 95% CI $332-$462; p < 0.001). When adjusting for covariates, higher OOP and total direct costs persisted for women for prescription services (OOP: $156; 95% CI $87-$225; p < 0.001 and total: $184; 95% CI $50-$318; p = 0.007). Women also paid > $50 OOP for office-based visits (p < 0.001) and > $55 total expenditures for home healthcare (p = 0.041) compared to men after adjustments.
CONCLUSIONS
Our findings show women with diabetes have higher OOP and total direct expenditures compared to men. Additional research is needed to investigate this disparity between men and women and to understand the associated drivers and clinical implications. Policy recommendations are warranted to minimize the higher burden of costs for women with diabetes.
背景
评估美国糖尿病成年男女医疗费用差异的证据很少；然而，有证据表明，与男性相比，女性的医疗保健支出通常更高。由于对这些差异了解甚少，本研究的目的是评估糖尿病成年患者的自付费用（OOP）和总医疗支出的差异。
方法
使用了2002 - 2011年医疗支出面板调查中20442名年龄≥18岁的糖尿病成年患者的数据。因变量是多种医疗服务（处方药、门诊、住院、门诊、急诊、牙科、家庭医疗保健及其他服务）的自付费用和总直接支出。自变量是性别。协变量包括社会人口统计学特征、合并症和时间。对样本人口统计学进行了总结。分析了按性别状况划分的医疗服务自付费用和总直接支出的均值。进行回归模型以评估糖尿病成年患者中按性别划分的医疗支出增量成本。
结果
样本中有56%为女性。与男性相比，女性在处方药方面的未调整平均自付费用更高（1177美元；95%置信区间1117 - 1237美元，而男性为959美元；95%置信区间918 - 1000美元；p < 0.001）。女性在处方药方面的未调整平均总直接支出也更高（3797美元；95%置信区间3660 - 3934美元，而男性为3334美元；95%置信区间3208 - 3460美元；p < 0.001）以及家庭医疗保健方面（752美元；95%置信区间646 - 858美元，而男性为397美元；95%置信区间332 - 462美元；p < 0.
Zotero 插件