基于医保数据分析我国2型糖尿病患者并发脑卒中的危险因素

Risk Factors Study for Stroke in Patients with Type 2 Diabetes Based on CHIRA Database

目的随着糖尿病患者迅速增加,糖尿病及其并发症的用药花费成为医保支出的沉重负担。本研究基于中国医疗保险研究会(CHIRA)国家医保数据分析我国2型糖尿病(T2DM)患者并发脑卒中的危险因素,以期从根源上控制脑卒中患者药品费用支出,降低医保基金的经济负担。方法收集2015年CHIRA数据库中T2DM患者数据,以卒中新患者为基准组,卡钳值取0.05,采用1∶1邻近匹配法筛选出基线一致的无卒中患者作为对照组。采用Logistic回归模型分析T2DM患者慢性并发症与脑卒中的相关性。结果共纳入T2DM患者65 081例,倾向性评分匹配(PSM)控制基线一致后纳入T2DM患者4 450例,卒中新患者2 225例;2 145例(48.20%)患者在确诊T2DM时伴有慢性并发症,其中1 138例发生脑卒中,发生率为53.05%,高于无慢性并发症患者47.16%(P<0.000 1)。Logistic回归分析结果显示,心血管并发症(OR=1.19,95%CI:1.05～1.34)、糖尿病周围神经病变(OR=1.34,95%CI:1.11～1.62)是脑卒中发病的独立危险因素。结论 T2DM伴有的心血管并发症和糖尿病周围神经病变是导致脑卒中发病的独立危险因素。

OBJECTIVE To analyze the risk factors for stroke in patients with type 2 diabetes in China by using CHIRA database and control the expenditure of medicine for stroke patients and reducing the economic burden of medical insurance funds. METHODS The data of T2DM patients in the 2015 CHIRA database were collected. The new stroke patients were used as a baseline group. The stroke-free patients who have the similar baseline were selected as the control group by using the PSM. At last, Logistic regression mod-el was used to analyze the relationship between chronic complications of type 2 diabetes and stroke in T2DM patients. RESULTS Four thousand four hundred and fifty patients were included after using the PSM. Two thousand one hunderd and forty-five（48.20%) patients were diagnosed with chronic complications and 1 138 patients were diagnosed with stroke （53.05%） , higher than patietnts who have no chronic complications （47.16% , P 〈 0. 0001). Logistic regression model showed that cardiovascular complication(OR = 1.19,95% CI： 1.05-1.34） and peripheral neuropathy （OR = 1.34,95% CI： 1.11-1.62） are independent risk factors for stroke. CONCLUSION Cardiovascular complication and peripheral neuropathy of patients with type 2 diabetes are independent risk factors for stroke.