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Li X, Tang K, Jin XR, Xiang Y, Xu J, Yang LL, Wang N, Li YF, Ji AL, Zhou LX, Cai TJ. Short-term air pollution exposure is associated with hospital length of stay and hospitalization costs among inpatients with type 2 diabetes: a hospital-based study. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2018; 81:819-829. [PMID: 30015599 DOI: 10.1080/15287394.2018.1491912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Air pollution is a risk factor for type 2 diabetes (T2D), exerting heavy economic burden on both individuals and societies. However, there is no apparent report regarding the influence of air pollutants such as particulate matter (PM2.5 and PM10), sulfur dioxide (SO2), carbon monoxide (CO), nitrogen dioxide (NO2), and ozone (O3) on financial burden to individuals and societies suffering from T2D. This study aimed to determine whether short-term (no more than 16 d) air pollution exposure was associated with T2D-related length of stay (LOS) and hospitalization expenses incurred by patients. This investigation examined 2840 T2D patients hospitalized from December 17, 2013 to May 31, 2016 in China. Multiple linear regression analysis was applied to determine the association between short-term (no more than 16 d) ambient air pollution, LOS, and hospitalization expenses, controlling for age, gender, ethnicity, marital status, and weather conditions. Sulfur dioxide (SO2) and carbon monoxide (CO) were significantly positively while nitrogen dioxide (NO2) was negatively associated with presence of T2D, LOS, and expenses. A 10-μg/m3 rise in 16-d (lag 0-15) average concentrations of SO2 and CO prior to hospitalization was correlated with a significant elevation in LOS and elevation in expenses in T2D patients. However, a 10-μg/m3 rise in 16-d average NO2 was associated with marked negative alterations in LOS and hospital costs in T2D patients. Taken together, data demonstrate that exposure to air pollutants impacts differently on LOS and hospitalization costs for T2D patients. This is the first apparent report regarding the correlation between air pollution exposure and clinical costs of T2D in China. It is of interest that air pollutants affected T2D patients differently as evidenced by LOS and clinical expenses where SO2 and CO exhibited a positive adverse relationship in contrast to NO2.
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Affiliation(s)
- Xiang Li
- a Department of Epidemiology, College of Preventive Medicine , Third Military Medical University (Army Medical University) , Chongqing , China
- b Fourth Battalion of Student Brigade , Third Military Medical University (Army Medical University) , Chongqing , China
| | - Kai Tang
- c Third Battalion of Student Brigade , Third Military Medical University (Army Medical University) , Chongqing , China
| | - Xu-Rui Jin
- b Fourth Battalion of Student Brigade , Third Military Medical University (Army Medical University) , Chongqing , China
| | - Ying Xiang
- a Department of Epidemiology, College of Preventive Medicine , Third Military Medical University (Army Medical University) , Chongqing , China
| | - Jing Xu
- d Department of Endocrinology , Xinqiao Hospital, Third Military Medical University (Army Medical University) , Chongqing , China
| | - Li-Li Yang
- e Department of Information , Xinqiao Hospital, Third Military Medical University (Army Medical University) , Chongqing , China
| | - Nan Wang
- f Medical department , Xinqiao Hospital, Third Military Medical University (Army Medical University) , Chongqing , China
| | - Ya-Fei Li
- a Department of Epidemiology, College of Preventive Medicine , Third Military Medical University (Army Medical University) , Chongqing , China
| | - Ai-Ling Ji
- g Department of Preventive Medicine & Chongqing Engineering Research Center of Pharmaceutical Sciences , Chongqing Medical and Pharmaceutical College , Chongqing , China
| | - Lai-Xin Zhou
- f Medical department , Xinqiao Hospital, Third Military Medical University (Army Medical University) , Chongqing , China
| | - Tong-Jian Cai
- a Department of Epidemiology, College of Preventive Medicine , Third Military Medical University (Army Medical University) , Chongqing , China
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Rosa R, Nita ME, Rached R, Donato B, Rahal E. Estimated hospitalizations attributable to Diabetes Mellitus within the public healthcare system in Brazil from 2008 to 2010: study DIAPS 79. Rev Assoc Med Bras (1992) 2014; 60:222-30. [DOI: 10.1590/1806-9282.60.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 09/01/2014] [Indexed: 11/21/2022] Open
Abstract
Objective: to estimate the number of hospitalizations attributable to diabetes mellitus (DM) and its complications within the public healthcare system in Brazil (SUS) and the mean cost paid per hospitalization. Methods: the official database from the Hospital Information System of the Unified Health System (SIH/SUS) was consulted from 2008 to 2010. The proportion of hospitalizations attributable to DM was estimated using attributable risk methodology. The mean cost per hospitalization corresponds to direct medical costs in nursing and intensive care, from the perspective of the SUS. Results: the proportion of hospitalizations attributable to DM accounted for 8.1% to 12.2% of total admissions in the period, varying according to use of maximum (self-reported with correction factor) or minimal (self-reported) DM prevalence. The hospitalization rate was 47 to 70.8 per 10.000 inhabitants per year. The mean cost per hospitalization varied from 1.302 Brazilian Reais (BRL) to 1,315 BRL. Assuming the maximum prevalence, hospitalizations were distributed as 10.3% as DM itself, 36.6% as chronic DM-associated complications and 53.1% as general medical conditions. Advancing age was accompanied by an increase in hospitalization rates and corresponding costs, and more pronounced in male patients. Conclusion: the results express the importance of DM in terms of the use of health care resources and demonstrate that studies of hospitalizations with DM as a primary diagnosis are not sufficient to assess the magnitude of the impact of this disease.
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Affiliation(s)
- Roger Rosa
- Federal University of Rio Grande do Sul, Brazil
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Caporale JE, Elgart JF, Gagliardino JJ. Diabetes in Argentina: cost and management of diabetes and its complications and challenges for health policy. Global Health 2013; 9:54. [PMID: 24168330 PMCID: PMC3826662 DOI: 10.1186/1744-8603-9-54] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 10/10/2013] [Indexed: 12/04/2022] Open
Abstract
Background Diabetes is an expensive disease in Argentina as well as worldwide, and its prevalence is continuously rising affecting the quality of life of people with the disease and their life expectancy. It also imposes a heavy burden to the national health care budget and on the economy in the form of productivity losses. Aims To review and discuss a) the reported evidence on diabetes prevalence, the degree of control, the cost of care and outcomes, b) available strategies to decrease the health and economic disease burden, and c) how the disease fits in the Argentinian health care system and policy. Finally, to propose evidence-based policy options to reduce the burden of diabetes, both from an epidemiological as well as an economic perspective, on the Argentinian society. The evidence presented is expected to help the local authorities to develop and implement effective diabetes care programmes. Methodology A comprehensive literature review was performed using databases such as MEDLINE, EMBASE and LILACS (Latin American and Caribbean Health Sciences). Literature published from 1980 to 2011 was included. This information was complemented with grey literature, including data from national and provincial official sources, personal communications and contacts with health authorities and diabetes experts in Argentina. Results Overall diabetes prevalence increased from 8.4% in 2005 to 9.6% 2009 at national level. In 2009, diabetes was the seventh leading cause of death with a mortality rate of 19.2 per 100,000 inhabitants, and it accounted for 1,328,802 DALYs lost in the adult population, mainly affecting women aged over fifty. The per capita hospitalisation cost for people with diabetes was significantly higher than for people without the disease, US$ 1,628 vs. US$ 833 in 2004. Evidence shows that implementation of combined educative interventions improved quality of care and outcomes, decreased treatment costs and optimised the use of economic resources. Conclusions Based on the evidence reviewed, we believe that the implementation of structured health care programmes including diabetes education at every level, could improve quality of care as well as its clinical, metabolic and economic outcomes. If implemented across the country, these programmes could decrease the disease burden and optimise the use of human and economic resources.
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Affiliation(s)
| | | | - Juan J Gagliardino
- CENEXA - Centro de Endocrinología Experimental y Aplicada (UNLP - CONICET La Plata, PAHO/WHO Collaborating Centre for Diabetes), Facultad de Ciencias Médicas UNLP, La Plata, Argentina.
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Ringborg A, Cropet C, Jönsson B, Gagliardino JJ, Ramachandran A, Lindgren P. Resource use associated with type 2 diabetes in Asia, Latin America, the Middle East and Africa: results from the International Diabetes Management Practices Study (IDMPS). Int J Clin Pract 2009; 63:997-1007. [PMID: 19570117 DOI: 10.1111/j.1742-1241.2009.02098.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS To estimate diabetes-related resource use and investigate its predictors among individuals with type 2 diabetes in 24 countries in Asia, Latin America, the Middle East and Africa. METHODS Cross-sectional observational data on diabetes-related resource use were collected from 15,016 individuals with type 2 diabetes within the second wave of International Diabetes Management Practices Study. Mean (SD) annual quantities were determined and predictors of diabetes-related hospitalisations, inpatient days, emergency room visits and absenteeism were investigated using negative binomial regression. RESULTS Patients in Asia (n = 4678), Latin America (n = 6090) and the Middle East and Africa (n = 4248) made a mean (SD) of 3.4 (6.9), 5.4 (6.7) and 2.5 (4.4) General Practitioner visits per year. The mean (SD) number of inpatient days amounted to 3.8 (18.1), 2.2 (13.9) and 2.6 (13.5) per year. Results of the regression analysis showed the major influence of diabetes-related complications and inadequate glycaemic control on resource use. The expected annual rate of hospitalisation of patients with macrovascular complications compared with those without was 4.7 times greater in Asia [incidence rate ratio (IRR) = 4.7, 95% CI: 2.8-7.8, n = 2551], 5.4 times greater in Latin America (IRR = 5.4, 95% CI: 3.0-9.8, n = 3228) and 4.4 times greater in the Middle East and Africa (IRR = 4.4, 95% CI: 2.8-6.9, n = 2630). CONCLUSIONS Micro- and macrovascular complications and inadequate glycaemic control are significant predictors of resource use in people with type 2 diabetes of developing countries. This knowledge confirms the health economic importance of early diagnosis of diabetes, education of patients and glycaemic control.
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Rosa RDS, Schmidt MI, Duncan BB, Souza MDFMD, Lima AKD, Moura LD. Internações por Diabetes Mellitus como diagnóstico principal na Rede Pública do Brasil, 1999-2001. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2007. [DOI: 10.1590/s1415-790x2007000400004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever no âmbito nacional e por faixa etária, sexo e região as 327.800 hospitalizações por diabetes mellitus (DM) da rede pública do Brasil, entre 1999-2001. MÉTODOS: Foram utilizados dados do Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS) referentes ao DM (diagnóstico principal CID-10 E10-E14 combinado com procedimento realizado) e indicadores anuais de hospitalizações/10(4)hab. e óbitos hospitalares/10(6)hab. (ajustados pelo método direto por idade), letalidade, médias de permanência e gastos por internação e por 10(4)hab. em US$, e regressão logística múltipla para desfecho óbito. RESULTADOS: Houve mais hospitalizações anuais do sexo feminino (7,5/10(4)hab. [intervalo de confiança de 95%: 7,4-7,6] vs. masculino (5,2/10(4)hab. [5,2-5,3]), mais óbitos hospitalares anuais de mulheres (38,1/10(6)hab. [36,8-39,3] vs. 30,7 [29,5-32,0]), porém maior letalidade no sexo masculino (5,9 vs. 5,0%) em todas as regiões. Observou-se incremento das hospitalizações com a idade, mais acentuado para mulheres. Não houve diferença na permanência das internações com óbito (6,5 dias [6,3-6,6]) ou sem (6,4 [6,3-6,6]), apesar do gasto por internação superior (US$ 275,27 [268,37-282,16] vs. 143,45 [136,56-150,35]). O gasto anual/10(4)hab. equivaleu a US$ 969,09. A razão de chances de óbito hospitalar aumentou com a idade, foi maior para homens (1,21 [1,17-1,24]) e 2 vezes maior para habitantes das regiões Nordeste e Sudeste comparados aos da região Sul. Os gastos anuais/10(4)hab. foram 50-100% maiores nas regiões mais desenvolvidas. CONCLUSÕES: O volume e a desigualdade nos gastos enfatizam a necessidade de cobertura mais adequada da população, evitando as hospitalizações e suas complicações.
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Selli L, Papaléo LK, Meneghel SN, Torneros JZ. Técnicas educacionales en el tratamiento de la diabetes. CAD SAUDE PUBLICA 2005; 21:1366-72. [PMID: 16158141 DOI: 10.1590/s0102-311x2005000500008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
El estudio consiste en aplicar un programa de educación para pacientes con diabetes tipo 2 y acompañar su evolución controlando las variables: glucemia, peso, índice de masa corporal, presiones arteriales y cuidado de los pies desde el diagnóstico inicial hasta un período que abarca 5 años. Estudio exploratorio desarrollado durante los años de 1996 hasta 2000. Se realizó sobre 189 pacientes, diagnosticados como diabéticos tipo 2, que fueron divididos en dos grupos: el primero, con 101 pacientes, se llamó adherentes, el segundo, con 88 pacientes, no adherentes, estos participaron durante menos de dos años. La investigación fue una intervención en educación para la salud y el autocuidado. Las variables que se utilizaron fueron: glucemia, peso, índice de masa corporal, presión arterial sistólica y diastólica. Las diferencias entre las tasas iniciales y finales presentaron reducción para todas las variables en el grupo llamado adherentes y para glucemia y presión arterial para los no adherentes. Todos mejoraron en relación al control de la alimentación, medicación, práctica de ejercicio y prevención del pie diabético demostrando la importancia de la prevención en salud.
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Affiliation(s)
- Lucilda Selli
- Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil.
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Lien LF, Spratt SE, Woods Z, Osborne KK, Feinglos MN. Optimizing Hospital Use of Intravenous Insulin Therapy: Improved Management of Hyperglycemia and Error Reduction With a New Nomogram. Endocr Pract 2005; 11:240-53. [PMID: 16006296 DOI: 10.4158/ep.11.4.240] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of intravenous (IV) insulin administration with use of our institution's old protocol (pre-nomogram phase) as compared with our new insulin nomogram (post-nomogram phase), which titrates insulin dose based on the rate of change of plasma glucose values and uses multipliers to determine the new insulin infusion rate. METHODS Hospitalized adults receiving an IV insulin infusion in our tertiary care medical center were enrolled in this study after informed consent was obtained. The study was an observational analysis conducted before and after implementation of the new insulin infusion nomogram. Measurements included episodes of hypoglycemia and incidence of the following errors in the insulin infusion process: (1) episodes of documented failure to increase insulin infusion rate despite persistent hyperglycemia and (2) number of times the IV infusion was stopped without subcutaneous administration of insulin. RESULTS Overall, 66 patients were analyzed (38 in the pre-nomogram phase and 28 in the post-nomogram phase). The new nomogram reduced by nearly 3-fold (from 0.89 +/- 0.68 to 0.36 +/- 0.49 occurrence per patient per 24 hours; P<0.001) the mean incidence of failure to give insulin subcutaneously before discontinuation of IV insulin infusion. Moreover, the nomogram nearly eliminated the error of caregiver nonresponsiveness to persistent hyperglycemia: mean incidence 0.39 +/- 0.65 occurrence per patient per 24 hours before implementation of the new nomogram versus 0.02 +/- 0.09 afterward (P<0.002). There was no statistically significant difference in episodes of hypoglycemia between the 2 study groups. CONCLUSION Safe IV administration of insulin through error prevention is essential. Implementation of a new IV insulin infusion nomogram, which adjusts insulin infusion using multipliers, reduces errors and improves glycemic control without increasing hypoglycemic episodes.
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Affiliation(s)
- Lillian F Lien
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina 27710, USA
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Ward MM, Yankey JW, Vaughn TE, BootsMiller BJ, Flach SD, Welke KF, Pendergast JF, Perlin J, Doebbeling BN. Physician Process and Patient Outcome Measures for Diabetes Care. Med Care 2004; 42:840-50. [PMID: 15319609 DOI: 10.1097/01.mlr.0000135809.92048.d9] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Optimal diabetes management relies on providers adhering to evidence-based practice guidelines in the processes of care delivery and patients adhering to self-management recommendations to maximize patient outcomes. PURPOSE To explore: (1) the degree to which providers adhere to the guidelines; (2) the extent of glycemic, lipid, and blood pressure control in patients with diabetes; and (3) the roles of organizational and patient population characteristics in affecting both provider adherence and patient outcome measures for diabetes. DESIGN Secondary data analysis of provider adherence and patient outcome measures from chart reviews, along with surveys of facility quality managers. SAMPLE We sampled 109 Veterans Affairs medical centers (VAMCs). RESULTS Analyses indicated that provider adherence to diabetes guidelines (ie, hemoglobin A1c, foot, eye, renal, and lipid screens) and patient outcome measures (ie, glycemic, lipid, and hypertension control plus nonsmoking status) are comparable or better in VAMCs than reported elsewhere. VAMCs with higher levels of provider adherence to diabetes guidelines had distinguishing organizational characteristics, including more frequent feedback on diabetes quality of care, designation of a guideline champion, timely implementation of quality-of-care changes, and greater acceptance of guideline applicability. VAMCs with better patient outcome measures for diabetes had more effective communication between physicians and nurses, used educational programs and Grand Rounds presentations to implement the diabetes guidelines, and had an overall patient population that was older and with a smaller percentage of black patients. CONCLUSIONS Healthcare organizations can adopt many of the identified organizational characteristics to enhance the delivery of care in their settings.
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Affiliation(s)
- Marcia M Ward
- Department of Health Management and Policy, University of Iowa, Iowa City, Iowa 52242-1008, USA.
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