美国患有糖尿病且伴有肾脏和眼部并发症的成年人的健康相关生活质量和医疗保健利用情况。
Health related quality of life and healthcare utilization among adults with diabetes and kidney and eye complications in the United States.
机构信息
Department of Clinical Pharmacy, College of Pharmacy, Jazan University, P.O Box 114-45124, Jazan, Saudi Arabia.
Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan, Saudi Arabia.
出版信息
Health Qual Life Outcomes. 2020 Mar 30;18(1):85. doi: 10.1186/s12955-020-01336-w.
BACKGROUND
One-third of adults with diabetes in the United States have chronic kidney disease (CKD), and 19% of them have eye complications (ECs). However, little is known about the Health-related Quality of Life (HRQoL) of adults with both of these diabetes-related complications. Therefore, the purpose of this study is to examine differences in the HRQoL, mental health, and healthcare utilization of adults with diabetes who have CKD, ECs, both or neither.
METHODS
A cross-sectional study design was implemented using data from multiple panels (2009-2015) of the Medical Expenditure Panel Survey. HRQoL was measured using the SF-12 Physical and Mental Component Summary (PCS & MCS) scores. The HRQoL, mental health, and healthcare utilization of four mutually exclusive groups: 1) diabetes with both CKD and ECs; 2) diabetes with CKD only; 3) diabetes with ECs only, and 4) diabetes with neither CKD nor ECs were compared. In all analyses, adults with neither CKD nor ECs were the reference group.
RESULTS
There were 8415 adults with diabetes who met the inclusion criteria. Approximately, 75% of the study sample had neither CKD nor ECs, 13.3% had ECs only, 5.7% had CKD only, and 5.5% had both CKD and ECs. In the adjusted analyses, adults with both CKD and/or ECs complications exhibited significantly lower HRQoL compared to those with neither CKD nor ECs. Mental illness and psychological distress were higher among adults with both CKD and ECs compared to those with neither CKD nor ECs. Furthermore, adults with CKD and/or ECs had higher polypharmacy, inpatient and emergency services use compared to those with neither CKD nor ECs.
CONCLUSIONS
The results indicate that the presence of both CKD and/or ECs was negatively associated with poor HRQoL, poor mental health, higher psychological distress and healthcare utilization in adults with diabetes. The findings emphasize the need for routine assessment and treatment for diabetes-related CKD and/or ECs complications to improve the quality of care for individuals with diabetes.
背景
美国三分之一的糖尿病患者患有慢性肾病（CKD），其中 19%的患者有眼部并发症（ECs）。然而，对于同时患有这两种糖尿病相关并发症的成年人的健康相关生活质量（HRQoL）知之甚少。因此，本研究的目的是研究患有 CKD、ECs、两者兼有或两者都没有的糖尿病成年人在 HRQoL、心理健康和医疗保健利用方面的差异。
方法
使用来自多个面板（2009-2015 年）的医疗支出面板调查数据，实施了一项横断面研究设计。使用 SF-12 身体和精神成分综合量表（PCS 和 MCS）分数来衡量 HRQoL。将四个互斥组的 HRQoL、心理健康和医疗保健利用进行比较：1）糖尿病伴 CKD 和 ECs；2）糖尿病伴 CKD 仅；3）糖尿病伴 ECs 仅，4）糖尿病伴 CKD 和 ECs 均无。在所有分析中，无 CKD 和 ECs 的成年人均为参照组。
结果
共有 8415 名符合纳入标准的糖尿病成年人。研究样本中约有 75%的人既没有 CKD 也没有 ECs，13.3%的人只有 ECs，5.7%的人只有 CKD，5.5%的人既有 CKD 又有 ECs。在调整后的分析中，同时患有 CKD 和/或 ECs 并发症的成年人的 HRQoL 明显低于既没有 CKD 也没有 ECs 的成年人。同时患有 CKD 和 ECs 的成年人的精神疾病和心理困扰比既没有 CKD 也没有 ECs 的成年人更高。此外，同时患有 CKD 和/或 ECs 的成年人比既没有 CKD 也没有 ECs 的成年人使用更多的药物、住院和急诊服务。
结论
结果表明，同时患有 CKD 和/或 ECs 与糖尿病成年人的 HRQoL 差、心理健康差、心理困扰程度高和医疗保健利用率高呈负相关。研究结果强调需要对糖尿病相关的 CKD 和/或 ECs 并发症进行常规评估和治疗，以提高糖尿病患者的护理质量。
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