Charateristics of Medical Services Utilization and Risk of Stroke amomg Diabetic Patients in Taiwan－Based on the NHI Database

• Main Authors: WU YA-CHUN, 吳亞純
• Other Authors: CHU NAIN-FENG
• Format: Others
• Language: zh-TW
• Published: 2009
• Online Access: http://ndltd.ncl.edu.tw/handle/83041985569192904696

碩士 === 國防醫學院 === 公共衛生學研究所 === 97 === Abstract Backgrownd：Diabetes is one of chronic diseases,also is a risk factor in many chronic diseases,it is easy to cause the patient death.The prevalence of Diabetes is keep growing, then the medical cost to increase.Diabetes has many comorbidities. Cardiovascular disease is the major cause to death in Diabetes patients. The studies say that it has correlation between diabetes and cardiovascular disease, and the antidiabetic medicines could decrease the risk of cardiovascular disease. Therefore, the relationship between antidiabetic medicines and cardiovascular disease is worth to study. Objective：The study aims to understand 1.2001~2005 Diabetes patient health care expenditures, and the situation of the antidiabetic medicines in Diabetes patient in Taiwan. 2. The different antidiabetic medicines could decrease the risk of cardiovascular disease in Taiwan. Methods：The study are Longitudinal study design and Crosss-sectional study design.The study subjects were from 2001~2005 National Health Insurance Database. The samples collected International Classification of Diseases（ICD-9）in base. The ICD-9 was 250, and login the number over 3 times in the same year. The samples aged over 20 year, and used antidiabetic medicines.The study has 3 cohorts. One was 2001 cohort , second was 2002 cohort and the last was conbine 2001 and 2002 cohort.The samples in 2001 cohort was 4060, the samples in 2002 cohort was 4411, the samples in conbine 2001 and 2002 cohort was 8434. The study used National Health Insurance Database to discuss health care expenditures in Diabetes patient, and the differentantidiabetic medicines could decrease the risk of cardiovascular disease. Results：The diabetes cases have the increase trend in 5 years. The health care expenditures in women were more than men, the health care expenditures in over 60 were more than under 60. Sulfonylureas was the most in simple prescription. Biguanide add sulfonylureas was the most in complex prescription. In 2001 cohort, the women case were more than men, the over 60 cases were more than under 60.The frequency of outpatient services in stroke case was higher than no stroke case in 2004（19.5 vs. 14.7 p＜0.05）. The cost of outpatient services in stroke case was higher than no stroke case in 2004（36540.7 vs. 28112.6 p＜0.05）. The cost of drugs in stroke case was higher than no stroke case in 2004（24172.5 vs. 20301.9 p＜0.05）.The 2002 cohort and the conbine 2001 and 2002 cohort were consistent. In 2001 cohort，Biguanide has lower risk than sulfonylureas（OR＝0.8；95%CI：0.2~4.0）；Biguanide add sulfonylureas has higher risk than sulfonylureas（OR＝1.0；95%CI：0.5~2.0）；Biguanide add sulfonylureas add Acarbose has lower risk than sulfonylureas（OR＝0.9；95%CI：0.4~2.0）。In 2002 cohort, Biguanide has lower risk than sulfonylureas（OR＝0.4；95%CI：0.1~2.9）；Biguanide add sulfonylureas has higher risk than sulfonylureas（OR＝1.5；95%CI：0.8~2.9）；Biguanide add sulfonylureas add Acarbose has higher risk than sulfonylureas（OR＝1.0；95%CI：0.4~2.3）.In conbine 2001 and 2002 cohort，Biguanide has lower risk than sulfonylureas（OR＝0.6；95%CI：0.2~2.0）；Biguanide add sulfonylureas has higher risk than sulfonylureas（OR＝1.2；95%CI：0.8~1.9）；Biguanide add sulfonylureas add Acarbose has lower risk than sulfonylureas（OR＝1.0；95%CI：0.5~1.7）。The three cohorts have the same situation. Conclusions：The health care expenditures in stroke case were higher than no stroke case, the health care expenditures increase in diabetes has comorbidities. The antidiabetic medicines were no statistically significant in risk of stroke, but the antidiabetic medicines should have some effect in stroke existence.