Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
Department of Environmental Health Sciences, University at Albany, the State University of New York, Rensselaer, New York, United States of America.
PLoS One. 2021 Apr 15;16(4):e0250200. doi: 10.1371/journal.pone.0250200. eCollection 2021.
The aim of this study was to determine the association between social determinants of health and direct economic burden on Chinese middle-aged and elderly individuals living with diabetes in China.
This study used data from the baseline wave of The China Health and Retirement Longitudinal Study (CHARLS) database, covering 17,708 middle-aged and elderly residents in China. The population with diabetes was grouped into those diagnosed with diabetes mellitus (DDM) and those undiagnosed with diabetes mellitus (UDM). Direct economic cost data, including total direct medical costs (TC) and out-of-pocket (OOP) payments, were extracted as outcome variables. A two-part model was applied to analyze the association between social determinants of health and direct economic burden.
In our analysis, we included 958 patients with DDM and 1,285 patients with UDM. The mean TC and OOP payments were 11,193 CNY (US $1,733; 6.46 CNY = 1 USD) and 7,266 CNY (US $1,125) in DDM patients, and 3,700 CNY (US $573) and 3,060 CNY (US $474) in UDM patients. Rural-urban status (p<0.05), regional status (p<0.05), household personal consumption expenditures (p<0.05), and comorbidities(p<0.05) were crucial factors associated with medical costs in people with diabetes.
Although progress has been made in the development of current health policies intended to contain the direct economic burden of diabetes, the gaps in that burden in populations with different social characteristics remains a burning issue. More policy breakthroughs are needed to achieve health equity.
本研究旨在探讨中国中老年糖尿病患者的健康社会决定因素与直接经济负担之间的关系。
本研究使用了中国健康与养老追踪调查（CHARLS）数据库基线数据，共纳入 17708 名中国中老年居民。根据是否患有糖尿病，将人群分为糖尿病患者（DM）和未诊断为糖尿病患者（UDM）。直接经济成本数据包括总直接医疗费用（TC）和自付费用（OOP），作为因变量进行提取。采用两部分模型分析健康社会决定因素与直接经济负担之间的关系。
在分析中，我们纳入了 958 名 DDM 患者和 1285 名 UDM 患者。DM 患者的平均 TC 和 OOP 支出分别为 11193 元人民币（1733 美元；6.46 元人民币=1 美元）和 7266 元人民币，UDM 患者的相应支出分别为 3700 元人民币和 3060 元人民币。城乡状况（p<0.05）、地区状况（p<0.05）、家庭人均消费支出（p<0.05）和合并症（p<0.05）是影响糖尿病患者医疗费用的重要因素。
尽管当前旨在控制糖尿病直接经济负担的卫生政策取得了一定进展，但不同社会特征人群之间的负担差距仍然是一个亟待解决的问题。需要更多的政策突破来实现健康公平。
