Date Published: February 23, 2010
Publisher: Public Library of Science
Author(s): Philip M. Clarke, Paul Glasziou, Anushka Patel, John Chalmers, Mark Woodward, Stephen B. Harrap, Joshua A. Salomon, Leif Groop
Abstract: Philip Clarke and colleagues examined patient-level data for over 11,000 participants with type 2 diabetes from 20 countries and find that major complications of diabetes significantly increased hospital use and costs across settings.
Partial Text: The prevalence of diabetes worldwide was estimated to be 2.8% in 2000 and projected to rise to 4.4% by 2030, with more than three-quarters of people with diabetes living in developing countries . Diabetes imposes a considerable burden in terms of premature mortality, morbidity, and health care costs. Life expectancy for people with diabetes has been estimated to be up to 10 y shorter than for people without diabetes –. Likewise diabetes imposes substantial demands on health care systems, as medical expenditures for people with diabetes are up to three times greater than for those without diabetes, largely because of macrovascular complications –.
Some regional differences were observed in the baseline characteristics of the population (Table 1). Compared with participants from Established Market Economies participants in the other regions were younger and more likely to be female. Blood pressure was substantially higher among Eastern European patients, who had a mean blood pressure at entry of 150/85 mm Hg. Body mass index was on average significantly lower among Asian patients.
In this study we have reported results from analyses of a large patient-level dataset collected in 20 countries (including seven countries in Eastern Europe and four in Asia) to obtain empirical estimates of the hospital use and indicative costs associated with a set of major complications that occur commonly in people with diabetes. There were significant differences in both the incidence of these complications and in patterns of hospital use across regions. Overall, patients in Asia and Eastern Europe had higher incidence of some events (e.g., stroke) than patients in Established Market Economies, lower rates of hospitalization, and longer lengths of stay. Specific complications varied markedly in their contributions to hospital use across regions. For example in Asia around 30% of days spent in hospital by people with diabetes could be attributed to stroke, whereas heart failure was more important in Eastern Europe. In both of these regions, major complications contributed a greater proportion of the hospital use recorded during the study than in Established Market Economies.