572220 research-article2015

APHXXX10.1177/1010539515572220Asia-Pacific Journal of Public HealthWang et al

Original Article

The Economic Burden of Inpatients With Type 2 Diabetes: A Case Study in a Chinese Hospital

Asia-Pacific Journal of Public Health 2015, Vol. 27(2S) 49­S–54S © 2015 APJPH Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1010539515572220 aph.sagepub.com

Hao Wang, PhD1, Xuan Lin, PhD2, Zhi Zhang, MD2, Quan Wang, PhD1, Jun-Mei Chen, MD2, Jing Liu, MD2, and Li Yuan, PhD2

Abstract The purpose of this research was to study the components, influencing factors, and their changing trend in a Chinese hospital, so as to reduce the economic burden of inpatients with type 2 diabetes. Data were collected from 7487 cases. There were 4368 inpatients with type 2 diabetes during 2002-2012 in a Chinese hospital. Multivariate linear regression analysis was performed to explore the influencing factors of hospitalization costs. The number of inpatients and their hospitalization costs had increasing trends in the study period. The medicine, test, and examination charges were the main sources of total costs. Longer hospital stays, older ages, and more times of hospitalization led to higher medical costs. Actions should be taken on all fronts to control the rapidly increasing trend of hospitalization costs and to reduce hospital stays and the number of times of hospitalization to reduce the economic burden of diabetic inpatients. Keywords type 2 diabetes, hospitalization costs, cost components, influencing factors

Introduction Diabetes mellitus is a growing public health problem that adversely affects the lives of millions of individuals around the world.1 Diabetes mellitus has been listed among the top 4 noncommunicable diseases that have leading threat to human health and development by the World Health Organization.2 The incidence of diabetes mellitus rises with age, which can significantly affect patients’ quality of life.3 The number of patients with type 2 diabetes has been increasing worldwide, especially in China, which has shown the greatest increase in the Asia-Pacific region.4 The increased prevalence of diabetes has a profound impact on the overall health care cost, and the cost of hospitalization is a large portion of the total costs for patients with type 2 diabetes.5 In China, the national economic burden of diabetes had increased from 2.216 billion (CNY) in 1993 to 200 billion (CNY) in 2007, and the number is expected to increase in the coming years.6 The

1Wuhan

University, School of Public Health/Global Health Institute, Wuhan, China General Hospital, Wuhan, China

2WISCO

Corresponding Author: Li Yuan, WISCO General Hospital, 430080, Wuhan, Hubei, China. Email: [email protected]

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Asia-Pacific Journal of Public Health 27(2S)

purpose of this research is to study the components, influencing factors, and their changing trends in a Chinese hospital, so as to reduce the economic burden of inpatients with type 2 diabetes.

Methods Study Design and Sample This study was based on the data from the Hospital Information System of WISCO general hospital, a grade 3 hospital in Wuhan, China, which has more than 1500 beds. The main variables we analyzed were hospitalization costs and its components, patients’ gender, age, times of hospitalization, and hospital stay, and so on. The hospitalization costs were adjusted by Health Care Consumer Price Index. Our study period was 2002-2012. The data consisted of 7477 cases. Of these, 4175 inpatients were diagnosed with type 2 diabetes for hospitalization, among whom 4368 were males and 3109 were females. The average age was 62 years, and the average hospital stay was 13.0 days. Of the 4175 inpatients, 2895 inpatients were one-time hospitalization patients, and 1280 were repeated hospitalization ones. For the latter, every hospitalization was studied as a case. This study was approved by the Medical Research Ethics Committee of WISCO General Hospital.

Statistical Analysis The distributions of hospitalization costs between subgroups were evaluated with Mann-Whitney U test. The correlations of hospitalization costs with various variables were examined using Spearman rank correlation. Multivariate linear regression analysis was performed to analyze the influencing factors of hospitalization costs, and the stepwise method was selected. Because the hospitalization costs did not conform to the normal distribution, the Box-Cox transformation was applied to it with λ = 0.25. All P values reported were 2 sided, and P < .05 was considered to be statistically significant. Statistical analyses were carried out using IBM SPSS Statistics 20.

Results Analysis of General Situation The number of type 2 diabetic inpatients had an increasing trend during 2002-2012. Compared with 2002 (346 cases), the number of inpatients had tripled in 2012 (1243 cases). The hospitalization costs also had an increasing trend after being adjusted by Health Care Consumer Price Index, and the daily cost grew faster than the total cost (Figure 1). The median value of the total cost was 4540 CNY. As shown in Figure 2, the cost of medicines was the main chunk of the total cost, followed by the costs for tests and examinations, and both of them showed increased trends during 20022012. The other costs included surgical, care services, traditional Chinese medicine, and so on. The median value for hospitalization cost for men was 4489.01 CNY, whereas it was 4605.24 CNY for women. No statistical difference was found between them (P = .139); the median value of age for our studied sample was 62 years old, and a positive correlation was found between inpatients’ age and their hospitalization cost (r = 0.149, P < .001); the average length of hospital stay had a decreased trend during 2002-2012—it was 21 days in 2002, whereas it dropped to 11 days in 2012. A positive correlation was found between hospital stay and total cost (r = 0.489, P

The economic burden of inpatients with type 2 diabetes: a case study in a Chinese hospital.

The purpose of this research was to study the components, influencing factors, and their changing trend in a Chinese hospital, so as to reduce the eco...
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