| Background Aging population is major consumers of medical services. Older people, which are living with chronic noncommunicable disease and always bear a long time of therapy and bad prognosis, have a higher morbidity and average medical costs than younger. Studies show that Chinese elderly bear a rapidly increased medical costs with increasing age. Circulatory diseases, such as coronary heart disease, hypertension and cerebrovascular disease, are main senile disease. Acute myocardial infarction (AMI) is the most dangerous and high mortality one. Percutaneous coronary intervention (PCI) is an effective therapy of AMI. However, due to the "silence" symptoms, delayed diagnosis and worry to tolerate the operation, older AMI patients have a lower usage rate of PCI. Aging is an important risk factor of type2diabetes mellitus (DM) and DM is at the same risk with coronary heart disease. Medical payment of DM patients is nine times payment of non-DM patients with same age and sex. It’s still unclear that whether stent implantation influence medical payment in aged AMI patients with DM.Material and methods Retrospective cohort study was conducted to analyze the effect of DM on AMI economic burden at hospital. Case files of consecutive patients with discharge diagnosis of AMI at Qilu Hospital of Shandong University during January2011to December2012were included. Identifying of DM is based on discharge diagnosis. A total of537patients were divided into two groups, one of which are younger man aged less than65(n=247) and the other group of which are the elderly aged65and older (n=290). All analyses were conducted using SPSS version17.0. Numerical variables were expressed as means±SD and two-sample t test was used. Nonnormal distribution variables were expressed as median (quartile deviation) and two-sample rank correlation analysis were used. Categorical variables were expressed as proportions (%) and the Χ2test and Fisher exact probability test were used. All tests were double tailed, with P<0.05considered statistically significant. Multiple linear regression using stepwise method was performed to examine influencing factors of medical costs of older AMI patients.Results1. Clinical featuresWe observed537case files of AMI patients with DM during January2011to December2012. Older patients counted290and young patients counted247. Patients with PCI counted276and patients without PCI counted261. In older patients,116people were with PCI and174people were not. In young patients,160people were with PCI and87people were not. Compared with young patients, older patients had a significant lower PCI usage (64.78%vs.40%, P=1*10-8).1.1Young patients compared with older patientsCompared with young patients, older patients had a higher proportion of female sex (43/204vs.138/152, P<0.001), significantly increased SBP (128±23vs.136±22, P<0.001), a significantly lower TG (1.84±1.02vs.1.42±0.78, P<0.001), a significantly higher HDL (1.07±0.25vs.1.13±0.25, P=0.009). Compared with young patients, older patients had a significantly lower BUN (9.36±3.43vs.6.38±3.25, P<0.001) and a significantly higher Cys-C (0.95±0.46vs.1.26±0.62, P<0.001).1.2Patients with PCI compared with patients without PCICompared with patients without PCI, patients with PCI were younger (69.9±11.2vs.61.8±12.0, P<0.001) and had a lower proportion of female sex (109/152vs.72/204, P<0.001).Compared with patients without PCI, patients with PCI had a significant lower SBP (135±22vs130±23, P<0.05). Compared with patients without PCI, patients with PCI had a significant higher TG (1.50±0.79vs.1.71±1.02, P=0.009) and a significant higher serum glucose (7.37±3.04vs.7.93±3.54, P=0.05).Compared with patients without PCI, patients with PCI had an obvious lower BUN (6.53±4.25vs.5.32±2.09, P<0.001), Cr (89.99±77.88vs.76.09±33.65, P<0.01) and Cys-c (1.25±0.71vs.0.99±0.36, P<0.001).Compared with patients without PCI, patients with PCI had an obvious higher CK-MB (22.53±61.14vs.42.71±93.84, P<0.01) and cTnl (8.34±21.55vs.14.75±35.29, P<0.05).2. Medical costs and days at hospital2.1Young patients compared with older patients Compared with young patients, older patients had an obvious lower total costs (53695.89±31847.65vs.42283.46±31840.04, P<0.001) and each day costs (5519.50±6178.82vs.3824.98±4168.62, P<0.001), but a longer hospital stay (11.62±5.39vs.13.30±7.06, P<0.01).2.2Patients with PCI compared with patients without PCICompared with patients without PCI, patients with PCI had an obvious higher total costs (30540.84±24877.53vs.63636.01±30273.29, P<0.001) and each day costs (2628.31±2617.38vs.6478.36±6337.67, P<0.001). Older patients with PCI lived a shorter days at hospital (13.03±7.29vs.12.05±5.38, P=0.076), which didn’t reach statistical significance.2.3Age-PCI interactionDifference of total costs between young patients and older patients was not significant (P=0.181). Difference of total costs between patients with and without PCI was significant (P=0.000). In aspect of total coats, age-PCI interaction was not significant (P=0.760).Difference of each day costs between young patients and older patients was not significant (P=0.070). Compared with patients without PCI, patients with PCI had a higher each day costs and difference reached statistical significance (P=0.000). In aspect of each day costs, age-PCI interaction was not significant (P=0.761).Difference of hospital stay between young patients and older patients reached statistical significance (P=0.006). Difference of hospital stay between patients with and without PCI was not significant (P=0.323). In aspect of hospital stay, age-PCI interaction was not significant (P=0.401). 3. Multiple linear regression of influencing factors of medical costs in AMI patients with DMTaking total coats as dependent variable to conduct multiple linear regression, results showed that PCI (β=0.498, P=0.000), cTnI (β=0.120, P=0.005) and sex (β=0.098, P=0.023) were influencing factors.Taking each day costs as dependent variable to conduct multiple linear regression, results showed that PCI (β=0.331, P=0.000), CK-MB (β=0.215, P=0.000), statins (p=-0.137, P=0.002), Cr (β=0.137, P=0.002) and AST (β=0.128, P=0.015) were influencing factors.Taking hospital stay as dependent variable to conduct multiple linear regression, results showed that age (β=0.224. P=0.000), sex (β=0.055, P=0.003) and β-blocker (β=-0.099, P=0.044) were influencing factors.4. Binary logistic regression of influencing factors of hospital stay in AMI patients with DMTaking delayed hospital stay which was longer than12days as dependent variable, binary logistic regression showed that age0=0.033, OR=1.034,95%CI [1.016,1.052], P=0.000), sex0=0.621, OR=1.861,95%CI [1.171,2.958], P=0.009) and p-blocker (β=-0.523, OR=0.593,95%CI [0.354,0.994], P=0.047) were influencing factors of hospital stay.Conclusion1. In AMI patients with DM, older patients have a higher blood pressure, more renal function impairment and longer hospital stay. But, older patients don’t have significant higher total costs and have a decreased each day costs. PCI bring patients improved renal function and make total costs and each day costs higher, hospital stay same.2. The influencing factor of hospital stay of AMI patients with DM are age, sex and β-blocker. Hospital stay is longer with increased age and male sex. Usage of β-blocker could shorten hospital stay.3. The influencing factor of total costs of AMI patients with DM are PCI, cTnl and sex. PCI is the main influencing factor. Total costs increase with high cTnl and male sex.4. The influencing factor of each day costs of AMI patients with DM are PCI, CK-MB, statins, Cr and AST. PCI is the main influencing factor. Each day costs increase with higher CK-MB, higher Cr and higher AST. Usage of statins could lower each day costs. |
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