| ObjectiveThe study takes middle-aged and elderly patients with diabetes as the research object,calculates their economic burden and risk of diseases,and explores the key factor that affect the diseases’ economic burden and risk.These can provide data support for reducing the diseases’ economic burden and risk of diabetic people.Starting with the high-risk group of diabetes epidemics,the study measures the economic burden and risk brought by the health expenditure of middle-aged and elderly patients with diabetes to Chinese society,and provides scientific decision-making basis for policymakers to improve diabetes prevention strategies and promote the rational allocation of health resources.MethodsThe study used the Direct Method to measure the direct economic burden and the Human Capital Method was used to measure the indirect economic burden.The Catastrophic Health Expenditure,Poor HealthExpenditure,and the Relative Risk of Disease were used to comprehensively analyze the diseases’ economic risk of middle-aged and elderly patients with diabetes.The ordered multi-class logistic regression and binary logistic regression were used to analyze the influencing factors of economic burden and economic risk of diseases Results1.Basic situationIn 2015,the prevalence of diabetes among middle-aged and elderly people was 9.62% and the prevalence of diabetes over 75 years of age was12.95%.The average income of middle-aged and diabetic patients was20219.28 yuan.Per capita outpatient,hospitalization,and self-treatment health expenditures were 3610.07 yuan,2340.56 yuan,and 2745.43 yuan,respectively.The rate of outpatient treatment,inpatient treatment and self-treatment of diabetics was 28.51%,27.52% and 66.82%,respectively,and there were 19.34% of diabetics who have not taken any treatment.2.Economic burden of diseasesIn 2015,the per capita direct economic burden of middle-aged and elderly patients with diabetes was 8893.03 yuan,and the total direct economic burden of the diabetics was 450.853 billion yuan.In 2015,the per capita indirect economic burden of middle-aged and elderly diabetics was 1,164.39 yuan,and the total indirect economic burden of the diabeticswas 59.023 billion yuan.In 2015,the per capita diseases’ economic burden was 10057.43 yuan,and the total diseases’ economic burden of the diabetics was 509.885 billion yuan.The economic burden of middle-aged and elderly diabetics and those suffering from 0,1,2,3,4,5,or more chronic disease comorbidities was 78.375 billion yuan,56.038 billion yuan,70.83 billion yuan,and 98.50 billion yuan,791.46 billion yuan and 127.447 billion yuan,respectively.And it’s proportion of the total economic burden was 15%,11%,14%,19%,16% and 25%,respectively.3.Economic risk of diseasesWhen the defined standards are 10%,15%,and 20%,the catastrophic health expenditures rate of middle-aged and elderly patients with diabetes was 51.60%,46.97%,and 42.50%,respectively,and the average gap of catastrophic health expenditures was 32.63%,30.18% and27.97%,respectively,at the same time,the relative gap of catastrophic health expenditures were 63.24%,64.27% and 65.80%,respectively.Among them,80% of the catastrophic health expenditures occurred in the patient group with annual household income below 50,000 yuan.Under the two poverty lines,the disease-induced poverty rate of middle-aged and elderly patients with diabetes was 12.68% and 11.96%,respectively,and the average poverty gap was 533.93 yuan and 509.14 yuan,respectively,at the same time,the relative poverty gap was 4211.11 yuan and 4256.13 yuan,respectively.Among them,80% of the poor health expenditure occur in the patient group with per capita household income of less than 11,000 yuan.The economic risk of middle-aged and elderly patients with diabetes is 1.76 times the average level of the middle-aged and elderly population.4.Influencing factorsRegression results of diseases’ economic burden: compared with the control group,the OR values of men,patients with other chronic disease comorbidities,urban employee basic medical insurance,urban residents medical insurance and new rural cooperative medical insurance are greater than 1,and their values are 1.26,1.16,1.60,1.64 and 1.42,respectively.Meanwhile,the OR value of patients with normal BMI index,good self-assessed health status,diagnosing diabetes by doctors and low economic income is less than 1.Regression results of catastrophic health expenditure: compared with the control group,the OR value of patients with obesity,other chronic disease comorbidities,poor self-assessed health status,diabetes without diagnosis by doctor and smoking cessation is greater than 1,and their values are 2.76,1.17,3.15,1.28 and 1.46,respectively.At the same time,the OR value of patients with high economic income is less than 1.Regression results of poor health expenditure: compared with the control group,the OR value of patients over 75 years old,obese,poorself-assessed health status,and inactivity are greater than 1,and their values are 1.86,3.07,2.43,and 1.46,respectively.Meanwhile,the OR value of patients with high economic income is less than 1.ConclusionsThe middle-aged and elderly patients with diabetes in China have a heavy disease economic burden and high economic risk,which brings great pressure to patients’ families and society,for example,the high proportion of patients’ health expenditure not only brings a heavy burden to patients but also hinders the improvement of family living standards.In terms of individual patients,a high disease economic burden does not necessarily lead to a high disease economic risk,but low-income patients above the poverty line have a higher risk of poverty due to disease,regardless of the disease economic burden.Factors such as low economic income,obesity,a large number of comorbidities,diabetes without diagnosis by a doctor,and inactivity are risk factors for patients’ high disease economic burden and high economic risk.The basic medical insurance will increase patients’ disease economic burden,but its role in resisting the economic risk of disease is not significant. |
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