Department of Health Administration, College of Health Science, Dankook University, Cheonan, Republic of Korea.
Institute of Health Promotion and Policy, Dankook University, Cheonan, Republic of Korea.
PLoS One. 2019 Jan 22;14(1):e0210809. doi: 10.1371/journal.pone.0210809. eCollection 2019.
This study investigates the effects of the number of medical institutions visited on risk of death. This study conducted a nested case-control design using the National Health Insurance Service-Senior database from 2002 to 2013. Cases were defined as those with death among outpatients who had first diagnosis of diabetes mellitus (E10-E14) after entry into the base cohort and controls were selected by incidence density sampling and matched to cases based on age, and sex. Our main results were presented by conditional logistic regression for nested case-controls design. Of total 55,558 final study samples, there were 9,313 (16.8%) cases and 46,245 (83.2%) controls. With an increase by one point in the number of hospitals per medical utilization, risk of death significantly increased by 4.1% (odds ratio (OR): 1.041, 95% confidence interval [CI]: 1.039-1.043). In both medical utilization and number of hospitals, those with high medical utilization (OR: 1.065, 95% CI: 1.059-1.070) and number of hospitals (OR: 1.049, 95% CI: 1.041-1.058) for risk of death were significantly higher than those with low medical utilization (OR: 1.040, 95% CI: 1.037-1.043) and number of hospitals (OR: 1.029, 95% CI: 1.027-1.032), respectively. The number of medical institution visited was significantly associated with risk of death. Therefore, diabetics should be warned about the potential of risk of death incurred from excessive access to medical utilizations.
本研究旨在探讨就诊医疗机构数量对死亡风险的影响。本研究采用 2002 年至 2013 年国家健康保险服务-老年人数据库，进行了巢式病例对照设计。病例定义为进入基础队列后首次诊断为糖尿病（E10-E14）的门诊患者死亡病例，对照通过发病率密度抽样选择，并根据年龄与病例匹配。我们的主要结果通过巢式病例对照设计的条件逻辑回归呈现。在总共 55558 例最终研究样本中，有 9313 例（16.8%）为病例，46245 例（83.2%）为对照。每增加一家医疗机构就诊，死亡风险显著增加 4.1%（比值比（OR）：1.041，95%置信区间[CI]：1.039-1.043）。在医疗利用率和医疗机构数量方面，高医疗利用率（OR：1.065，95%CI：1.059-1.070）和高医疗机构数量（OR：1.049，95%CI：1.041-1.058）的患者死亡风险显著高于低医疗利用率（OR：1.040，95%CI：1.037-1.043）和低医疗机构数量（OR：1.029，95%CI：1.027-1.032）。就诊医疗机构数量与死亡风险显著相关。因此，应警告糖尿病患者过度就医可能带来的死亡风险。
