密歇根州 Medicare 受益人群中的 2 型糖尿病和慢性病差异。
Type 2 Diabetes and Chronic Conditions Disparities in Medicare Beneficiaries in the State of Michigan.
机构信息
Central Michigan University, College of Medicine, Mount Pleasant, Michigan.
Central Michigan University, College of Medicine, Mount Pleasant, Michigan.
出版信息
Am J Med Sci. 2020 Apr;359(4):218-225. doi: 10.1016/j.amjms.2020.01.013. Epub 2020 Jan 23.
BACKGROUND
This study aimed to describe the prevalence of type 2 diabetes and combinations of multiple chronic conditions (MCCs) that are leading causes of death (LCD) and confirm that disparities exist between groups based on race and sex.
MATERIALS AND METHODS
We conducted a retrospective cohort study using 2012 Medicare claims data from beneficiaries with type 2 diabetes over the age of 65 in the state of Michigan.
RESULTS
Female beneficiaries have type 2 diabetes and 1 or more MCCs that are LCD more often than males. Most type 2 diabetes patients have diabetes alone without MCCs, while a large proportion have at least 1 additional chronic condition that is a LCD. One in 3 patients have 3 or more chronic conditions. The most prevalent type 2 diabetes coexisting MCCs are congestive heart failure (CHF), chronic obstructive pulmonary disease and chronic kidney disease. Asian/Pacific Islanders have the highest prevalence of type 2 diabetes without MCCs, and the highest prevalence of diabetes plus CHF. While fewer black beneficiaries have diabetes alone or 1 additional MCC, the prevalence of 3 or more MCCs in blacks generally exceeds the prevalence in other races. In beneficiaries with newly diagnosed type 2 diabetes, chronic obstructive pulmonary disease and CHF are the first new chronic conditions to be diagnosed after an initial type 2 diabetes diagnosis.
CONCLUSIONS
Race and sex disparities occur in the prevalence of type 2 diabetes and MCCs that are LCD in Medicare beneficiaries in the state of Michigan.
背景
本研究旨在描述密歇根州 65 岁以上患有 2 型糖尿病的医疗保险受益人群中 2 型糖尿病的患病率和多种合并慢性病（MCC），这些 MCC 是主要的死亡原因（LCD），并确认基于种族和性别的差异确实存在。
材料与方法
我们对密歇根州的医疗保险受益人进行了回顾性队列研究，研究对象为年龄在 65 岁以上患有 2 型糖尿病的患者。
结果
女性受益人群患有 2 型糖尿病和 1 种或更多的 LCD 合并症的比例高于男性。大多数 2 型糖尿病患者仅患有糖尿病而没有合并症，而很大一部分患者至少有 1 种其他的慢性疾病，这些慢性疾病是 LCD。每 3 个患者中就有 3 个或更多的慢性疾病。最常见的 2 型糖尿病共存的 MCC 是充血性心力衰竭（CHF）、慢性阻塞性肺疾病和慢性肾脏病。亚裔/太平洋岛民患有无 MCC 的 2 型糖尿病的比例最高，且患有糖尿病加 CHF 的比例最高。虽然黑人受益人群中仅患有糖尿病或 1 种其他合并症的比例较低，但黑人中 3 种或更多合并症的患病率通常高于其他种族。在新诊断为 2 型糖尿病的受益人群中，慢性阻塞性肺疾病和 CHF 是继初始 2 型糖尿病诊断后首次诊断出的新的慢性疾病。
结论
在密歇根州的医疗保险受益人群中，2 型糖尿病和 MCC 的患病率存在种族和性别差异，这些 MCC 是 Medicare 的主要死亡原因。
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