The Study On The Burden Of Diabetes In China

As a consequence of increasing urbanization and associated lifestyle changes, diabetes mellitus has emerged as a major and growing public health problem in China. It is of great importance to measure its impact on population health and social development. This study is based on late data of epidemics of diabetes in China and the formulae proposed by International Diabetes Federation (IDF) to estimate the direct economic burden of diabetes. Health-related quality of life of patients with diabetes is the other important content in this study. The study aimed to provide timely imformation on the burden of diabetes in China for health policy makers and researchers to take effective action to battle the disease.Part 1 The Study on Epidemiological Burden of Diabetes in ChinaOBJECTIVE To analyze the changes in prevalence of diabetes from 1993 to 2003, as well as the health sevice utiliaztion of diabetic patients from 2000 to 2005. To measure the years of life lost (YLL) and the indirect economic burden due to diabetes in 2005. METHODS Trend analysis and the formula used by WHO in estimating global burden of diseases were employed. The calucation of indirect economic burden was based on the formula used by WHO and World Bank. RESULTS From 1993—2003, the prevalence of diabetes in urban and rural area increased by 194.73% and 375%. The health service utilization of diabetic patients rose rapidly. The proportion of inpatients with diabetes in all hospitalized patients raised by 34.75% in city hospitals and 13.43% in county hospitals. The YLLs due to diabetes was 154.82 per 100000 in the urban and 87.96 per 100000 in rural area and 105.75 per 100000 in whole country in 2005. The YLLs in females was more than those in males wherever in urban and rural area. The YLLs in the urban area was about 2 times that in rural area. The indirect economic burden incurred by YLLs was 8.068 billion Yuan. CONCLUSIONS The prevalence of diabetes imposes heavy burden on population health and the indirect economic burden is substantial. More efforts should be taken to prevent and control diabetes. Part2 The Study on Direct Economic Burden of Diabetes in ChinaOBJECTIVE To estimate the direct health expenditure of diabetes in 2005 in China. To evaluate the feasibility of appling the formula proposed by IDF in China. METHODS Matched case-control design was used to calculate the ratio of direct health expenditure between 618 diabetic patients and 618 individuals without diabetes. The matched factors were age, sex, and medical insurance status. The socioeconomic and biological factors were explored by multiple liner regression model and those factors significantly influence the direct health expenditure of diabetic patients were identified. RESULTS Direct health expenditure for diabetic patients per person was 2.47 times that for individuals without diabetes. The direct health expenditure for diabetic patients was 65.568 billion Yuan in 2005, which accounted for 7.57% national health expenditure. The direct health expenditure due to diabetes was 39.022 billion Yuan. The formulae were proved to be reliable. Multiple liner regression analysis showed age, retiring, complications and comorbities, educational level, medical insurance, treatment, smoking, drinking, dyslipidemia, have significant influence on direct health expenditure for diabetic patients.The medical examination revealed only 13.92% patients reached target level of fasting blood glucose concentrations, 38.19% reached target level of HbA1c, 14.08% controlled their blood pressure well, 22.01% controlled their blood cholesterol concentrations well, 49.36% males and 40.78% females were overweight. CONCLUSIONS Diabetes produces considerable direct economic burden. The proportion of direct health expenditure for diabetic patients in national health expenditure reached a high level, which was even larger than in some developed countries. The formulae proposed by IDF could be used in estimating the direct health expenditure due to diabetes although more evidences should be collected to evaluate it throughly. More efforts should be taken to reduce the risk factors of diabetic chronic complications.Part3 The Study on Medical Expense of Inpatients with DiabetesOBJECTIVE To compare the medical expenses for inpatients with diabetes and its 9 main chronic complications. METHODS 2381 inpatients with diabetes and its 9 main chronic complications were extracted from a tertiary hospital in Shanghai. One-way ANOVA was employed to compare the medical expenses for these diseases. Grey correlations analysis was used to indentify those factors influencing medical expense. RESULTS The medical expenses of inpatients with cardiovascular complications (29946.27 yuan) and cerebrovascular complications (17289.30 yuan) and low limbs complications (13918.42 yuan) were significant higher than other inpatients. From 2000-2005, the average length of day of the inpatients was 21 days and declined from 24 days to 15 days. The medical expense per day for inpatients with cardiovascular complications was highest (1225.04 yuan) and the patients without complitations were the lowest (360.37). Expense on pharmaceuticals was the largest component in medical expense (36.50%) and was the most important expense driver. CONCLUSIONS The medical expense on diabetic complications is huge. More efforts should be given to prevent and control these diseases in their early stages; especially the cardiovascular complications; cerebrovascular complications; and low limbs complications.Part4 Case Control Study on the Health Related Quality of Life of Type 2 Diabetic Patients and People without DiabetesOBJECTIVE To compare the health related quality of life (HRQoL) between type 2 diabetic patients and nondiabetic individuals. To explore the factors associated with HRQoL of diabetic patients. To examine the reliability and validity of EQ-5D instrument in measuring the HRQoL of diabetic patients. METHODS Multiple liner regression analysis and binary logistic analysis were used to explore the relationship between HRQoL and characters of patients. RESULTS The results revealed type 2 diabetes had significant adverse effect on HRQoL. Factors including age, sex, number of family members, family income level, size of housing, smoking, diet control, complications, taking exercise and abnormal blood cholesterol concentrations had statistical significance correlations with HRQoL of diabetic patients. CONCLUSIONS Efforts to improve the HRQoL of diabetic patients include managing the complications and blood cholesterol concentrations, promoting smoking cessation and taking exercise, caring for the psychology of solitary and youngers. This suggests EQ-5D is a reliable and valid instrument in measuring the HRQoL of diabetic patients. Howerer, EQ-5D has significant ceiling effect in measuring HRQoL of diabetic patients and nondiabetic individuals.