Center for Community Health and Aging, Texas A&M University, College Station, TX, United States of America.
Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, United States of America.
BMC Health Serv Res. 2023 Oct 18;23(1):1116. doi: 10.1186/s12913-023-10118-1.
The trend of Type 2 diabetes-related costs over 4 years could be classified into different groups. Patient demographics, clinical factors (e.g., A1C, short- and long-term complications), and rurality could be associated with different trends of cost. Study objectives are to: (1) understand the trajectories of cost in different groups; (2) investigate the relationship between cost and key factors in each cost trajectory group; and (3) assess significant factors associated with different cost trajectories.
Commercial claims data in Texas from 2016 to 2019 were provided by a large commercial insurer and were analyzed using group-based trajectory analysis, longitudinal analysis of cost, and logistic regression analyses of different trends of cost.
Five groups of distinct trends of Type 2 diabetes-related cost were identified. Close to 20% of patients had an increasing cost trend over the 4 years. High A1C values, diabetes complications, and other comorbidities were significantly associated with higher Type 2 diabetes costs and higher chances of increasing trend over time. Rurality was significantly associated with higher chances of increasing trend over time.
Group-based trajectory analysis revealed distinct patient groups with increased cost and stable cost at low, medium, and high levels in the 4-year period. The significant associations found between the trend of cost and A1C, complications, and rurality have important policy and program implications for potentially improving health outcomes and constraining healthcare costs.
在 4 年内，2 型糖尿病相关成本的趋势可以分为不同的组别。患者人口统计学特征、临床因素（如 A1C、短期和长期并发症）和农村地区可能与不同的成本趋势相关。研究目的是：（1）了解不同组别成本的轨迹；（2）调查每个成本轨迹组中成本与关键因素之间的关系；（3）评估与不同成本轨迹相关的显著因素。
得克萨斯州一家大型商业保险公司提供了 2016 年至 2019 年的商业索赔数据，使用基于群组的轨迹分析、成本纵向分析和不同成本趋势的逻辑回归分析进行了分析。
确定了 5 组不同的 2 型糖尿病相关成本趋势。近 20%的患者在 4 年内呈现成本不断增加的趋势。高 A1C 值、糖尿病并发症和其他合并症与 2 型糖尿病成本较高和随着时间的推移成本增加趋势的几率较高显著相关。农村地区与随着时间的推移成本增加趋势的几率较高显著相关。
基于群组的轨迹分析揭示了在 4 年期间，具有成本增加和稳定成本（低、中、高）的不同患者群组。发现成本趋势与 A1C、并发症和农村地区之间的显著关联对潜在改善健康结果和控制医疗保健成本具有重要的政策和计划意义。
