scholarly journals The impact of cardiovascular disease and chronic kidney disease on life expectancy and direct medical cost in a 10-year diabetes cohort study

2020 ◽  
Author(s):  
Eric Yuk Fai Wan ◽  
Weng Yee Chin ◽  
Esther Yee Tak Yu ◽  
Ian Chi Kei Wong ◽  
Esther Wai Yin Chan ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Heart Disease ◽  
Kidney Disease ◽  
Life Expectancy ◽  
Medical Cost ◽  
Medical Costs ◽  
Mortality Risks ◽  
Direct Medical Costs ◽  
Patients With Diabetes

<b>Objective</b> <p>The relative effects of various cardiovascular diseases (CVD) and varying severity of chronic kidney disease (CKD) on mortality risk, direct medical cost and life expectancy in patients with diabetes mellitus (DM) are unclear. The aim of this study was to evaluate these associations. </p> <p> </p> <p><b>Research Design and Methods <br> </b>This was a retrospective cohort study that included 208,792 adults with diabetes stratified into 12 disease status groups with varying combinations of heart disease, stroke, moderate CKD (eGFR:30-59ml/min/1.73m<sup>2</sup>) and severe CKD (eGFR: <30ml/min/1.73m<sup>2</sup>) in 2008-2010. The effect of risk mortality, annual direct medical costs and life expectancy were assessed using Cox regression, <a></a><a></a><a>Gamma generalized linear with log link function</a>, and flexible parametric survival models. </p> <p> </p> <p><b>Results</b></p> <p>Over a median follow-up of 8.5 years (1.6 million patient-years), 50,154 deaths were recorded. Mortality risks for patients with only a single condition among heart disease, stroke and moderate CKD were similar. The mortality risks were 1.75 times, 2.63 times and 3.58 times greater for patients with one, two and all three conditions (consisting of stroke, heart disease and moderate CKD), compared with patients without these diseases, suggesting an independent and individually additive effect for any combination. A similar trend was observed in annual public healthcare costs with 2.91, 3.90 and 3.88 fold increased costs for patients with one, two and three conditions, respectively. Increases in the number of conditions reduced life expectancy greatly, particularly in younger patients. Reduction in life expectancy for a 40-year-old with one, two and three conditions were 20, 25, 30 years for men and 25, 30, 35 years for women. A similar trend of greater magnitude was observed for severe CKD.</p> <p> </p> <p><b>Conclusion</b></p> <p>The effect of heart diseases, stroke, CKD and the combination of these conditions on all-cause mortality and direct medical costs are independent and cumulative. CKD, especially severe CKD, appears to have a particularly significant impact on life expectancy and direct medical costs in patients with diabetes. These finding supports the importance of preventing both CVD and CKD in patients with DM.</p>

scholarly journals The impact of cardiovascular disease and chronic kidney disease on life expectancy and direct medical cost in a 10-year diabetes cohort study

2020 ◽  
Author(s):  
Eric Yuk Fai Wan ◽  
Weng Yee Chin ◽  
Esther Yee Tak Yu ◽  
Ian Chi Kei Wong ◽  
Esther Wai Yin Chan ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Heart Disease ◽  
Kidney Disease ◽  
Life Expectancy ◽  
Medical Cost ◽  
Medical Costs ◽  
Mortality Risks ◽  
Direct Medical Costs ◽  
Patients With Diabetes

<b>Objective</b> <p>The relative effects of various cardiovascular diseases (CVD) and varying severity of chronic kidney disease (CKD) on mortality risk, direct medical cost and life expectancy in patients with diabetes mellitus (DM) are unclear. The aim of this study was to evaluate these associations. </p> <p> </p> <p><b>Research Design and Methods <br> </b>This was a retrospective cohort study that included 208,792 adults with diabetes stratified into 12 disease status groups with varying combinations of heart disease, stroke, moderate CKD (eGFR:30-59ml/min/1.73m<sup>2</sup>) and severe CKD (eGFR: <30ml/min/1.73m<sup>2</sup>) in 2008-2010. The effect of risk mortality, annual direct medical costs and life expectancy were assessed using Cox regression, <a></a><a></a><a>Gamma generalized linear with log link function</a>, and flexible parametric survival models. </p> <p> </p> <p><b>Results</b></p> <p>Over a median follow-up of 8.5 years (1.6 million patient-years), 50,154 deaths were recorded. Mortality risks for patients with only a single condition among heart disease, stroke and moderate CKD were similar. The mortality risks were 1.75 times, 2.63 times and 3.58 times greater for patients with one, two and all three conditions (consisting of stroke, heart disease and moderate CKD), compared with patients without these diseases, suggesting an independent and individually additive effect for any combination. A similar trend was observed in annual public healthcare costs with 2.91, 3.90 and 3.88 fold increased costs for patients with one, two and three conditions, respectively. Increases in the number of conditions reduced life expectancy greatly, particularly in younger patients. Reduction in life expectancy for a 40-year-old with one, two and three conditions were 20, 25, 30 years for men and 25, 30, 35 years for women. A similar trend of greater magnitude was observed for severe CKD.</p> <p> </p> <p><b>Conclusion</b></p> <p>The effect of heart diseases, stroke, CKD and the combination of these conditions on all-cause mortality and direct medical costs are independent and cumulative. CKD, especially severe CKD, appears to have a particularly significant impact on life expectancy and direct medical costs in patients with diabetes. These finding supports the importance of preventing both CVD and CKD in patients with DM.</p>

scholarly journals The Impact of Cardiovascular Disease and Chronic Kidney Disease on Life Expectancy and Direct Medical Cost in a 10-Year Diabetes Cohort Study

Diabetes Care ◽  
2020 ◽  
Vol 43 (8) ◽  
pp. 1750-1758
Author(s):  
Eric Yuk Fai Wan ◽  
Weng Yee Chin ◽  
Esther Yee Tak Yu ◽  
Ian Chi Kei Wong ◽  
Esther Wai Yin Chan ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Life Expectancy ◽  
Direct Medical Cost ◽  
Medical Cost ◽  
The Impact

scholarly journals Burden of CKD and Cardiovascular Disease on Life Expectancy and Health Service Utilization: a Cohort Study of Hong Kong Chinese Hypertensive Patients

2019 ◽  
Vol 30 (10) ◽  
pp. 1991-1999 ◽  
Author(s):  
Eric Yuk Fai Wan ◽  
Esther Yee Tak Yu ◽  
Weng Yee Chin ◽  
Daniel Yee Tak Fong ◽  
Edmond Pui Hang Choi ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Hong Kong ◽  
Heart Disease ◽  
Life Expectancy ◽  
Mortality Risk ◽  
Medical Costs ◽  
Direct Medical Costs ◽  
Risk Of Mortality ◽  
Care Costs

BackgroundThe relative effects of combinations of CKD, heart disease, and stroke on risk of mortality, direct medical costs, and life expectancy are unknown.MethodsIn a retrospective cohort study of 506,849 Chinese adults in Hong Kong with hypertension, we used Cox regressions to examine associations between all-cause mortality and combinations of moderate CKD (eGFR of 30–59 ml/min per 1.73 m2), severe CKD (eGFR of 15–29 ml/min per 1.73 m2), heart disease (coronary heart disease or heart failure), and stroke, and modeling to estimate annual public direct medical costs and life expectancy.ResultsOver a median follow-up of 5.8 years (2.73 million person-years), 55,666 deaths occurred. Having an increasing number of comorbidities was associated with incremental increases in mortality risk and medical costs and reductions in life expectancy. Compared with patients who had neither CKD nor cardiovascular disease, patients with one, two, or three conditions (heart disease, stroke, and moderate CKD) had relative risk of mortality increased by about 70%, 160%, and 290%, respectively; direct medical costs increased by about 70%, 160%, and 280%, respectively; and life expectancy at age 60 years decreased by about 5, 10, and 15 years, respectively. Burdens were higher with severe CKD.ConclusionsThis study demonstrated extremely high mortality risk and medical cost increases for severe CKD, exceeding the combined effects from heart disease and stroke. Mortality risks and costs for moderate CKD, heart disease, and stroke were similar individually and roughly multiplicative for any combination. These findings suggest that to reduce mortality and health care costs in patients with hypertension, CKD prevention and intervention merits priority equal to that of cardiovascular disease.

scholarly journals Frailty modifies the association between opioid use and mortality in chronic kidney disease patients with diabetes: a population-based cohort study

Aging ◽  
2020 ◽  
Vol 12 (21) ◽  
pp. 21730-21746
Author(s):  
Szu-Ying Lee ◽  
Jui Wang ◽  
Chia-Ter Chao ◽  
Kuo-Liong Chien ◽  
Jenq-Wen Huang ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Population Based ◽  
Opioid Use ◽  
Patients With Diabetes

131: Medical Costs of Chronic Kidney Disease in Patients with Diabetes: A Managed Care Perspective

2008 ◽  
Vol 51 (4) ◽  
pp. B60
Author(s):  
François Laliberté ◽  
Brahim Bookhart ◽  
Francis Vekeman ◽  
Mitra Corral ◽  
Mei-Sheng Duh ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Managed Care ◽  
Medical Costs ◽  
Patients With Diabetes

scholarly journals Medical Costs Associated with Severity of Chronic Kidney Disease in Type 2 Diabetes Mellitus in Singapore

2020 ◽  
Vol 49 (10) ◽  
pp. 731-741
Author(s):  
Gwyneth J Lim ◽  
Yan Lun Liu ◽  
Serena Low ◽  
Keven Ang ◽  
Subramaniam Tavintharan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Type 2 Diabetes Mellitus ◽  
Kidney Disease ◽  
Medical Costs ◽  
Direct Medical Costs ◽  
Disease Costs ◽  
The Impact

Introduction: This was a retrospective cross-sectional study to assess the impact of chronic kidney disease (CKD) and its severity in Type 2 diabetes mellitus (T2DM) on direct medical costs, and the effects of economic burden on CKD related complications in T2DM in Singapore. Methods: A total of 1,275 T2DM patients were recruited by the diabetes centre at Khoo Teck Puat Hospital from 2011–2014. CKD stages were classified based on improving global outcome (KDIGO) categories, namely the estimated glomerular filtration rate (eGFR) and albuminuria kidney disease. Medical costs were extracted from the hospital administrative database. Results: CKD occurred in 57.3% of patients. The total mean cost ratio for CKD relative to non-CKD was 2.2 (P<0.001). Mean (median) baseline annual unadjusted costs were significantly higher with increasing CKD severity—S$1,523 (S$949), S$2,065 (S$1,198), S$3,502 (S$1,613), and S$5,328 (S$2,556) for low, moderate, high, and very high risk respectively (P<0.001). CKD (P<0.001), age at study entry (P=0.001), Malay ethnicity (P=0.035), duration of diabetes mellitus (DM; P<0.001), use of statins/fibrates (P=0.021), and modified Diabetes Complications Severity Index (DCSI) (P<0.001) were positively associated with mean annual direct medical costs in the univariate analysis. In the fully adjusted model, association with mean annual total costs persisted for CKD, CKD severity and modified DCSI. Conclusion: The presence and increased severity of CKD is significantly associated with higher direct medical costs in T2DM patients. Actively preventing the occurrence and progression in DM-induced CKD may significantly reduce healthcare resource consumption and healthcare costs. Keywords: Chronic kidney disease, costs, endocrinology, nephrology

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