Survey On Lifestyle Behaviors And Cost Analysis Among Outpatients With Type 2 Diabetes

Objective: To identify distinct patterns of person with type 2 diabetes based on personal levels of lifestyle behaviors and explore the characteristics across these subgroups,lay a foundation for the development of targeted health intervention plan.To analyze the medical expenses structure and tendency among outpatients with type 2 diabetes and explore the factor which influence diabetes outpatient costs.Methods: In 2015 and 2016,1,504 outpatients with type 2 diabetes were selected via two-stage simple random sampling from 10 municipal district hospitals in Tianjin.Latent class analysis was used to identify subgroup of lifestyle behaviors.Multinomial logistic regression was applied to explore the characteristics of the subgroups.A total of 71,786 cases of patients with type 2 diabetes were randomly selected for cost analysis from the Tianjin Basic Medical Insurance Register System dataset from 2010 to 2014.A description of the medical expenses can help us understand the outpatient cost structure.A multi-level statistical model was used to analyze the factors affecting the cost of diabetes.All analyses were performed using SAS9.3.Results: 1.The final model yielded a four-class solution: the healthy behavioral group,unhealthy diet and less activity group,smoking and drinking group,and sedentary and extremely inactive group.Further analysis found that "Abdominal obesity,unsatisfactory glycemic control,long duration of diabetes,and more diabetes-related disease" were more observed in the unhealthy diet and lack of exercise group(class 2),"male,aged 45-64" were more distributed in smoking drinking group(class 3),and "female,obesity,unsatisfactory glycemic control " were more appeared in sedentary and extremely inactive group(class 4).2.Medical expenses analysis:(1)in 2010-2014,the outpatient cost structure was stable,with the mainly composition was drug charge(90.8%-92.3%),followed by examination(3.7%-4.7%),medical materials(2.8%-3.2%),treatment(0.9%-1.0%)and other fees(0.3%).The total cost showed growth trend,with a slight decline only in 2012.(2)Results from the univariate analysis showed that gender,age,hospital level,management type,frequency of clinical visits,number of complications,macro-and micro-vascular complications,number of comorbidities were significant determinants of outpatient expenditure in people with type 2 diabetes(P < 0.05).(3)The multilevel analysis showed that the hospital level and management type as level 2 explanatory variables were statistically significant,the cost of tertiary hospital were higher than primary/secondary hospital,the expenses in private hospitals were higher than public hospitals.At the individual level,the cost of female patients is higher than that of male.With the increasing frequency of clinical visits,the outpatient costs were rising,and varied by different hospitals.Compared with no complications,patients with complications had higher treatment costs,and the cost increased with the number of complications.Type of complications was also influence factor of medical expenses,patients with microvascular complications may undertake greater financial burden.Conclusion: The cost in outpatients with type 2 diabetes is mainly comprised of drugs,and the overall trend was still upwards.The multilevel analysis showed that high level hospital,private hospital,female patients,frequency of clinical visits,and more complications or comorbidities can lead to higher medical expenses.We should accelerate the development of basic health institutions,strengthen their management and control over diabetes and its complications,improve the quality of integrated services,and guide patients to choose medical institutions rationally.Standardize the management of private hospitals and promote the development of the whole medical service market.Identification and characterization of categories on the basis of lifestyle behaviors in persons with type 2 diabetes can help health care providers to shift to targeted intervention strategies,improve the efficiency of diabetes prevention and management.Early prevention and effective management of diabetes should be taken into account,so as to reduce the burden of diabetes care fundamentally.