Currie C J, Morgan C L, Gill L, Stott N C, Peters J R
Department of Public Health Medicine, Bro Tâf Health Authority, Cardiff, Wales, UK.
Stroke. 1997 Jun;28(6):1142-6. doi: 10.1161/01.str.28.6.1142.
Little is known about the pattern of cerebrovascular disease (CVD) for diabetic and nondiabetic patients or about the cost of treatment for CVD in the United Kingdom. The purpose of this study was to extend previous work to describe the epidemiology and cost of acute care of CVD as a frequent comorbidity of diabetes in a UK population (408 000 people).
Routine data describing inpatient care for a 4-year period were analyzed (financial years 1991/1992 to 1994/1995). These data had undergone record linkage to draw together records from the same patients. Cost estimates were determined by attributing a diagnosis-related group cost weight to each record. Mortality data from an overlapping period were supplied by the Office of Population Censuses and Surveys.
There were 11 196 CVD admissions (3.1% of all admissions). Of these, 7351 (66%) were primary diagnoses. These admissions were generated by 5358 patients (3904 primary diagnosis). For people with diabetes, the incidence rate was between 23 and 32.8 per 1000 per year compared with 2.4 to 3.3 per 1000 for the population as a whole, depending on the use of primary and subsidiary codes. The age-adjusted relative risk of stroke in diabetic men versus nondiabetic men was 3.70 (95% confidence interval, 3.53 to 3.88) and in women was 4.35 (95% confidence interval, 4.37 to 4.76). We describe other epidemiological relationships. The cost of CVD is between pounds 1.1 and pounds 1.6 million per 100 000 population-at least pounds 0.7 million per 100 000 for CVD alone. Approximately 15% of this value is related to diabetes, and an estimated 94% of this diabetes-related expenditure is potentially avoidable.
CVD represents a major source of expenditure for health services, and diabetes is confirmed as a major risk factor within this disease group. Differences between diabetic and nondiabetic inpatient patterns of CVD may reflect greater incidence of comorbidities in the former.
对于糖尿病患者和非糖尿病患者的脑血管疾病（CVD）模式以及英国CVD的治疗费用，人们了解甚少。本研究的目的是扩展先前的工作，以描述作为英国人群（40.8万人）中糖尿病常见合并症的CVD急性护理的流行病学和费用情况。
分析了描述4年期间住院护理的常规数据（1991/1992财政年度至1994/1995财政年度）。这些数据已经过记录链接，以汇总来自同一患者的记录。通过为每条记录赋予一个与诊断相关的组成本权重来确定成本估计值。重叠期间的死亡率数据由人口普查与调查办公室提供。
有11196例CVD住院病例（占所有住院病例的3.1%）。其中，7351例（66%）为主要诊断。这些住院病例由5358名患者产生（3904例主要诊断）。对于糖尿病患者，发病率为每年每千分之23至32.8，而总体人群为每千分之2.4至3.3，这取决于主要和辅助编码的使用情况。糖尿病男性与非糖尿病男性相比，年龄调整后的中风相对风险为3.70（95%置信区间，3.53至3.88），女性为4.35（95%置信区间，4.37至4.76）。我们描述了其他流行病学关系。CVD的费用为每10万人口110万至160万英镑——仅CVD就至少为每10万人口70万英镑。该值的约15%与糖尿病有关，估计与糖尿病相关的支出中约94%可能是可以避免的。
CVD是卫生服务支出的主要来源，糖尿病被确认为该疾病组中的主要危险因素。糖尿病患者和非糖尿病患者CVD住院模式的差异可能反映了前者合并症的发生率更高。
