Ramirez Marcelo, Bianco Antonio C, Ettleson Matthew D
Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, IL 60637, USA.
J Endocr Soc. 2024 Nov 18;9(1):bvae204. doi: 10.1210/jendso/bvae204. eCollection 2024 Nov 26.
Suboptimal treatment of hypothyroidism (HT) is associated with adverse cardiovascular disease (CVD) outcomes, for which patients with diabetes mellitus (DM) are at increased risk.
This study aimed to compare CVD-related healthcare utilization in DM patients with and without HT in the US population.
Participant data were collected from the Medical Expenditure Panel Survey (MEPS) over 10 years (2011-2020). Medical conditions were identified by ICD-9/ICD-10 codes associated with expenditures. Healthcare utilization outcomes included number of emergency, hospital, and outpatient visits associated with coronary artery disease (CAD), stroke/transient ischemic attack (TIA), or heart failure; prescriptions related to CVD; and number of visits to specialty providers. A propensity score-based fine stratification matching approach was used to balance sociodemographic covariates to determine the relative risk (RR) contributed by HT on CVD-related care utilization.
A total of 15 580 adult participants with DM were identified, of whom 11.9% had treated HT. In the weighted analysis, a significantly greater proportion of participants with HT had CAD and stroke/TIA-associated visits compared to those without HT (respectively, 22.4% vs 17.8%, .002; and 7.3% vs 5.4%, .020). In the matched analysis, participants with HT were more likely to see a specialist (cardiology, endocrinology, and nephrology). Participants with HT were more likely to be treated with cholesterol-lowering medications, beta-blockers, and diuretics.
HT as a comorbidity with DM was associated with increased healthcare utilization related to CVD, specifically visits associated with stroke/TIA, increased use of specialty care, and greater utilization of CVD-related medications.
甲状腺功能减退症（HT）治疗不充分与不良心血管疾病（CVD）结局相关，糖尿病（DM）患者发生这些不良结局的风险更高。
本研究旨在比较美国人群中患HT和未患HT的DM患者的CVD相关医疗保健利用情况。
从医疗支出面板调查（MEPS）中收集了10年（2011 - 2020年）的参与者数据。通过与支出相关的ICD - 9/ICD - 10编码确定医疗状况。医疗保健利用结局包括与冠状动脉疾病（CAD）、中风/短暂性脑缺血发作（TIA）或心力衰竭相关的急诊、住院和门诊就诊次数；与CVD相关的处方；以及专科医生就诊次数。采用基于倾向评分的精细分层匹配方法来平衡社会人口统计学协变量，以确定HT对CVD相关医疗保健利用的相对风险（RR）。
共识别出15580名成年DM参与者，其中11.9%接受过HT治疗。在加权分析中，与未患HT的参与者相比，患HT的参与者中因CAD和中风/TIA相关就诊的比例显著更高（分别为22.4%对17.8%，P = 0.002；7.3%对5.4%，P = 0.020）。在匹配分析中，患HT的参与者更有可能看专科医生（心脏病学、内分泌学和肾脏病学）。患HT的参与者更有可能接受降胆固醇药物、β受体阻滞剂和利尿剂治疗。
HT作为DM的合并症与CVD相关的医疗保健利用增加有关，特别是与中风/TIA相关的就诊、专科护理使用增加以及CVD相关药物使用增加。
