美国成年糖尿病患者中与费用相关的胰岛素配给与医疗保健利用之间的关联
The Association Between Cost-Related Insulin Rationing and Health Care Utilization in U.S. Adults With Diabetes.
作者信息
Borden Caroline G, Bakkila Baylee F, Nally Laura M, Lipska Kasia J
机构信息
Yale School of Medicine, New Haven, CT.
Section of Pediatric Endocrinology, Department of Pediatrics, Yale School of Medicine, New Haven, CT.
出版信息
Diabetes Care. 2025 Mar 1;48(3):400-404. doi: 10.2337/dc24-2117.
OBJECTIVE
To examine the association between insulin rationing and health care utilization.
RESEARCH DESIGN AND METHODS
Cross-sectional study of all 2021 National Health Interview Survey respondents with diabetes using insulin. Logistic regression and zero-inflated negative binomial regression models examined associations between insulin rationing (skipping, delaying, or reducing insulin to save money) and 1) emergency department (ED) visit or hospitalization and 2) number of urgent care visits. All analyses were age-stratified and used survey weights.
RESULTS
Among 982 respondents representing 7,593,944 U.S. adults (median age 61 years, 47% women), 17% reported rationing. Among adults 18-64 years old, rationing was not significantly associated with health care utilization. Among adults ≥65 years old, rationing was associated with more urgent care visits (relative risk 2.1, 95% CI 1.2-3.6) but not with odds of ED visit or hospitalization (odds ratio 0.7, 95% CI 0.3-1.4).
CONCLUSIONS
Insulin rationing was not associated with higher health care utilization, but concurrent rationing of health care may mask a relationship.
目的
研究胰岛素定量配给与医疗保健利用之间的关联。
研究设计与方法
对2021年全国健康访谈调查中所有使用胰岛素的糖尿病受访者进行横断面研究。逻辑回归和零膨胀负二项回归模型用于研究胰岛素定量配给（为省钱而跳过、推迟或减少胰岛素用量）与1）急诊就诊或住院以及2）紧急护理就诊次数之间的关联。所有分析均按年龄分层并使用调查权重。
结果
在代表7593944名美国成年人（中位年龄61岁，47%为女性）的982名受访者中，17%报告存在定量配给情况。在18 - 64岁的成年人中，定量配给与医疗保健利用无显著关联。在65岁及以上的成年人中，定量配给与更多的紧急护理就诊相关（相对风险2.1，95%置信区间1.2 - 3.6），但与急诊就诊或住院几率无关（优势比0.7，95%置信区间0.3 - 1.4）。
结论
胰岛素定量配给与更高的医疗保健利用无关，但同时进行的医疗保健定量配给可能掩盖了一种关系。
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