糖尿病与住院频率和费用的关联：一项回顾性队列研究。
Association of diabetes with frequency and cost of hospital admissions: a retrospective cohort study.
机构信息
Department of Medicine (Choi), University of Toronto; Li Ka Shing Knowledge Institute (Booth, Jung, Verma, Razak) and Department of Medicine, Division of Endocrinology (Booth), St. Michael's Hospital; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network; Program of Medicine and Institute for Better Health (Tang), Trillium Health Partners; Division of General Internal Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Verma, Razak), St. Michael's Hospital, Toronto, Ont.
出版信息
CMAJ Open. 2021 Apr 16;9(2):E406-E412. doi: 10.9778/cmajo.20190213. Print 2021 Apr-Jun.
BACKGROUND
Acute inpatient hospital admissions account for more than half of all health care costs related to diabetes. We sought to identify the most common and costly conditions leading to hospital admission among patients with diabetes compared with patients without diabetes.
METHODS
We used data from the General Internal Medicine Inpatient Initiative (GEMINI) study, a retrospective cohort study, of all patients admitted to a general internal medicine service at 7 Toronto hospitals between 2010 and 2015. The Canadian Institute for Health Information (CIHI) Most Responsible Diagnosis code was used to identify the 10 most frequent reasons for admission in patients with diabetes. Cost of hospital admission was estimated using the CIHI Resource Intensity Weight. Comparisons were made between patients with or without diabetes using the Pearson χ test for frequency and distribution-free confidence intervals (CIs) for median cost.
RESULTS
Among the 150 499 hospital admissions in our study, 41 934 (27.8%) involved patients with diabetes. Compared with patients without diabetes, hospital admissions because of soft tissue and bone infections were most frequent (2.5% v. 1.9%; prevalence ratio [PR] 1.28, 95% CI 1.19-1.37) and costly (Can$8794 v. Can$5845; cost ratio [CR] 1.50, 95% CI 1.37-1.65) among patients with diabetes. This was followed by urinary tract infections (PR 1.16, 95% CI 1.11-1.22; CR 1.23, 95% CI 1.17-1.29), stroke (PR 1.13, 95% CI 1.07-1.19; CR 1.19, 95% CI 1.14-1.25) and electrolyte disorders (PR 1.11, 95% CI 1.03-1.20; CR 1.20, 95% CI 1.08-1.34).
INTERPRETATION
Soft tissue and bone infections, urinary tract infections, stroke and electrolyte disorders are associated with a greater frequency and cost of hospital admissions in patients with diabetes than in those without diabetes. Preventive strategies focused on reducing hospital admissions secondary to these disorders may be beneficial in patients with diabetes.
背景
急性住院患者的医疗费用占糖尿病相关医疗费用的一半以上。我们旨在确定与非糖尿病患者相比，导致糖尿病患者住院的最常见和最昂贵的疾病。
方法
我们使用了 2010 年至 2015 年期间在多伦多的 7 家综合内科服务机构接受综合内科住院治疗的所有患者的一般内科住院患者倡议（GEMINI）研究的回顾性队列研究数据。加拿大卫生信息研究所（CIHI）的主要责任诊断代码用于确定糖尿病患者住院的 10 个最常见原因。使用 CIHI 资源强度权重估算住院费用。使用 Pearson χ 检验比较有无糖尿病患者的频率和分布自由置信区间（CI）中位数成本。
结果
在我们的研究中，共有 150499 例住院患者，其中 41934 例（27.8%）患有糖尿病。与非糖尿病患者相比，软组织和骨骼感染导致的住院最为常见（2.5%比 1.9%；患病率比 [PR]1.28，95%CI1.19-1.37），且费用更高（加元 8794 比加元 5845；成本比 [CR]1.50，95%CI1.37-1.65）。其次是尿路感染（PR1.16，95%CI1.11-1.22；CR1.23，95%CI1.17-1.29）、中风（PR1.13，95%CI1.07-1.19；CR1.19，95%CI1.14-1.25）和电解质紊乱（PR1.11，95%CI1.03-1.20；CR1.20，95%CI1.08-1.34）。
解释
软组织和骨骼感染、尿路感染、中风和电解质紊乱与糖尿病患者住院的频率和费用增加有关，而与非糖尿病患者相比。针对这些疾病的住院治疗，实施预防策略可能对糖尿病患者有益。
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