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首页> 外文期刊>Diabetes care >Universal Drug Coverage and Socioeconomic Disparities in Health Care Costs Among Persons With Diabetes
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Universal Drug Coverage and Socioeconomic Disparities in Health Care Costs Among Persons With Diabetes

机译：患有糖尿病人类的普遍药物覆盖和社会经济差异

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OBJECTIVE To examine whether neighborhood socioeconomic status (SES) is a predictor of non-drug-related health care costs among Canadian adults with diabetes and, if so, whether SES disparities in costs are reduced after age 65 years, when universal drug coverage commences as an insurable benefit. RESEARCH DESIGN AND METHODS Administrative health databases were used to examine publicly funded health care expenditures among 698,113 younger (20-64 years) and older (>= 65 years) adults with diabetes in Ontario from April 2004 to March 2014. Generalized linear models were constructed to examine relative and absolute differences in health care costs (total and non-drug-related costs) across neighborhood SES quintiles, by age, with adjustment for differences in age, sex, diabetes duration, and comorbidity. RESULTS Unadjusted costs per person-year in the lowest SES quintile (Q1) versus the highest (Q5) were 39% higher among younger adults ($5,954 vs. $4,270 [Canadian dollars]) but only 9% higher among older adults ($10,917 vs. $9,993). Adjusted non-drug costs (primarily for hospitalizations and physician visits) were $1,569 per person-year higher among younger adults in Q1 vs. Q5 (modeled relative cost difference: 35.7% higher) and $139.3 million per year among all individuals in Q1. Scenarios in which these excess costs per person-year were decreased by >= 10% or matched the relative difference among seniors suggested a potential for savings in the range of $26.0-$128.2 million per year among all lower-SES adults under age 65 years (Q1-Q4). CONCLUSIONS SES is a predictor of diabetes-related health care costs in our setting, more so among adults under age 65 years, a group that lacks universal drug coverage under Ontario's health care system. Non-drug-related health care costs were more than one-third higher in younger, lower-SES adults, translating to >$1 billion more in health care expenditures over 10 years.
机译：目的探讨邻里社会经济地位（SES）是否是加拿大成年人与糖尿病的非药物有关的医疗费用的预测因素，如果是，如果是，在65岁之后，在65岁之后，当普遍药物覆盖范围开始时，是否降低了成本的差异。一个可保利益。研究设计和方法行政卫生数据库用于在2004年4月至2014年4月至2014年3月在安大略省的698,113名年轻（20-64岁）和老年人（> = 65岁）中进行公共资助的医疗费用。普遍的线性模型是建造的根据年龄划分邻域昆虫的医疗费用（总和非毒品相关成本）的亲属和绝对差异，调整年龄，性别，糖尿病持续时间和合并症差异。结果最低的SES五分（Q1）与最高（Q5）相比每人的不调整成本（Q5）在较年轻的成年人中较高39％（5,954美元，5,270美元[加拿大人]），但老年人只有9％更高（10,917美元。 $ 9,993）。在Q1与Q5的年幼的成年人中，调整后的非药物成本（主要用于住院和医生访问）为每人每人每年1,569美元，Q1中的Q5（相对成本差异：35.7％）和Q1中的所有个人中的每年13.93亿美元。这些方案，其中每人每年的多余成本下降> = 10％或匹配，老年人的相对差异建议在65岁以下的所有下半年成年人中储蓄的潜力为26.0-12820万美元（ Q1-Q4）。结论SES是我们的环境中糖尿病相关医疗费用的预测因子，其中65岁以下的成年人，这是在安大略省医疗保健系统下缺乏普遍的药物报道的集团。与毒品相关的医疗保健成本超过较年轻的低层成年人的三分之一，在10年内翻译成10亿美元的卫生保健支出。

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