北京地区糖尿病合并骨关节炎患者医保费用使用情况的纵向分析

Longitudinal analysis of medical insuance premiums for diabetes patients with osteoarthritis in Beijing

目的分析北京地区糖尿病合并骨关节炎(OA)患者的医保费用使用情况,探讨OA对糖尿病患者经济负担的影响。方法纳入2016至2018年北京医保,年龄>16岁、有完整门诊病历的糖尿病患者,除外随访不足2个月,无处方纪录者。从北京医疗保险数据库收集信息,包括糖尿病及并发症和合并症国际疾病分类、年龄、性别、病程、药物(降糖和非降糖药物)治疗方案和医保费用。应用多变量回归模型控制混杂因素,采用Wilcoxon秩和检验、χ^(2)检验或Fisher精确检验比较糖尿病未合并OA组和糖尿病合并OA组患者的各指标差异。结果共纳入符合标准的糖尿病患者2853036例,合并OA患者673251例(23.60%)。根据年龄进行分层,合并OA的糖尿病患者在45~84岁比例更多,2016、2017和2018年分别为92.73%、92.43%和92.29%。根据性别分布,合并OA的糖尿病患者中女性更多,2016、2017和2018年分别为55.17%、54.41%和53.37%。与未合并OA的糖尿病患者比较,合并OA的糖尿病患者发生相关合并症和并发症明显增多(P<0.001)。与未合并OA的糖尿病患者比较,2018年合并OA的糖尿病患者用药种类更多,分别为(4.42±2.37)和(3.75±2.34)种,年药物总费用也高,分别为(9729±9199)和(11735±10260)元,其中降糖药种类和费用以及非降糖药种类和费用均更高(P<0.001)。与未合并OA的糖尿病患者相比,2018年合并OA的糖尿病患者年药物总费用/药物数更高,分别为(2511±2526)和(2608±2155)元/种,其中降糖药费用/药物数和非降糖药费用/药物数均更高。2016至2018年,合并OA的糖尿病患者用药种类(特别是降糖药的种类)呈逐年上升趋势,年药物总费用(包括降糖药及非降糖药)呈下降趋势,年药物总费用/药物数同样呈下降趋势。结论合并OA的糖尿病患者有更多的糖尿病并发症和相关合并症,需要更多的降糖药物和医保费用,OA明显增加了糖尿病患者的医保费用。

Objective To analyze the use of medical insurance expenses of diabetic patients with osteoarthritis(OA)in Beijing,and to explore the impact of OA on the economic burden of diabetes patients.Methods Diabetic patients aged>16 years with complete outpatient medical records from 2016 to 2018 in Beijing medical insurance were included,excluding those with less than 2 months of follow-up and no prescription records.Information was collected from the Beijing medical insurance database,including the international disease classification of diabetes and its complications and comorbidities,age,sex,disease course,drug(hypoglycemic and non-hypoglycemic drugs)treatment plan,and medical insurance costs.Multivariate regression model was used to control confounding factors,and Wilcoxon rank sum test,χ^(2) test or Fisher exact test were used to compare the differences in various indicators between the patients with diabetes without OA and those with diabetes with OA.Results A total of 2853036 diabetic patients were included,of whom 673251 patients(23.60%)had OA.Stratified by age,the proportion of diabetics with OA was higher in the 45-84 age group,92.73%,92.43%and 92.29%in 2016,2017 and 2018,respectively.According to gender distribution,there were more females in diabetics with OA,55.17%,54.41%and 53.37%in 2016,2017 and 2018,respectively.Compared with diabetics without OA,diabetics with OA had significantly more related to complications and comorbidities(P<0.001).Compared with diabetics without OA,the total annual drug cost/drug number of diabetics with OA in 2018 was higher at(2511±2526)and(2608±2155)yuan/drug,respectively,of which the cost/drug number of hypoglycemic drugs and non-hypoglycemic drugs was higher.From 2016 to 2018,the types of drugs for diabetics with OA(especially the types of hypoglycemic drugs)showed an increasing trend year by year,while the total annual drug cost(including hypoglycemic drugs and non-hypoglycemic drugs)showed a decreasing trend,and the total annual drug cost/drug number of medications also showed a decreasing trend.Conclusions Diabetics with osteoarthritis have more diabetes complications and related comorbidities,and require more hypoglycemic drugs and medical expenses.Osteoarthritis significantly increases the medical expenses of diabetics.