Williams Joni S, Egede Leonard E
Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Womens Health Rep (New Rochelle). 2020 Sep 15;1(1):345-353. doi: 10.1089/whr.2020.0050. eCollection 2020.
Evidence suggests that women have increased health care costs; however, little is known about expenditures for women with diabetes compared with men with diabetes. The objective of this study was to calculate expenditures for men and women and to identify factors associated with increased costs in women. Adults with diabetes ( = 2,078) from the 2011 Medical Expenditure Panel Survey (MEPS) were identified. A generalized linear model with gamma distribution and log link was used to estimate incremental expenditure in women compared with men and to identify reasons for this difference. Sequential models were analyzed by entering variables in blocks (demographics, medical comorbidities, mental comorbidity and disability, and functional limitation). IRB approval was waived for this secondary data analysis. Unadjusted mean total expenditures were $12,485 for women with diabetes compared with $10,828 for men ( = 0.04). In the model with demographic variables and medical comorbidities, expenditures for women increased to $1,720 ( = 0.03) (95% confidence interval [CI] 164-3,266) compared with men. With a comorbid mental health disorder, expenditures for women decreased slightly, but they remained significantly higher than for men at $1,668 ( = 0.04) (95% CI 104-3,222). In the final analysis with all variables, incremental expenditures increased by $1,314 for women compared with men and were no longer statistically significantly higher than for men ( = 0.10; 95% CI -257 to 2,933). Our findings show that women with diabetes have increased expenditures for health care compared with men with diabetes. Increased functional limitation and disability in women account for incremental increases in costs, which suggest a need for more efforts to manage disability burden in women with diabetes.
有证据表明女性的医疗保健成本更高；然而，与患有糖尿病的男性相比，对于患有糖尿病的女性的支出情况却知之甚少。本研究的目的是计算男性和女性的支出，并确定与女性成本增加相关的因素。从2011年医疗支出面板调查（MEPS）中识别出患有糖尿病的成年人（n = 2078）。使用具有伽马分布和对数链接的广义线性模型来估计女性相对于男性的增量支出，并确定这种差异的原因。通过分块输入变量（人口统计学、医疗合并症、精神合并症和残疾以及功能限制）来分析顺序模型。对于这项二次数据分析，机构审查委员会（IRB）的批准被豁免。未调整的糖尿病女性平均总支出为12485美元，而男性为10828美元（P = 0.04）。在包含人口统计学变量和医疗合并症的模型中，与男性相比，女性的支出增加到1720美元（P = 0.03）（95%置信区间[CI] 164 - 3266）。患有心理健康合并症时，女性的支出略有下降，但仍显著高于男性，为1668美元（P = 0.04）（95% CI 104 - 3222）。在包含所有变量的最终分析中，与男性相比，女性的增量支出增加了1314美元，但不再显著高于男性（P = 0.10；95% CI -257至2933）。我们的研究结果表明，与患有糖尿病的男性相比，患有糖尿病的女性的医疗保健支出增加。女性功能限制和残疾的增加导致成本的增量增加，这表明需要做出更多努力来管理糖尿病女性的残疾负担。
