Introduction
Data and methods
Data
Reasons for inpatient admission | Test of difference in mean† | |||||||
---|---|---|---|---|---|---|---|---|
All observations | Newly diagnosed | Treatment-experienced | ||||||
Variable | Mean | Std dev | Mean | Std dev | Mean | Std dev | Diff or ratio | 95% CI |
Panel A: Sir Run Run Shaw Hospital
| ||||||||
(N = 960) | (N = 134) | (N = 849) | ||||||
Patient age | 55.60 | 12.89 | 49.91 | 12.18 | 56.52 | 12.78 | -6.61 | [-8.93 - -4.29] |
Female
| 0.43 | 0.28 | 0.46 | 0.60 | [0.45 - 0.80] | |||
< High School
| 0.58 | 0.61 | 0.57 | 1.07 | [0.92 - 1.24] | |||
Insured
| 0.20 | 0.19 | 0.21 | 0.91 | [0.62 - 1.32] | |||
Semi-insured
| 0.44 | 0.42 | 0.44 | 0.95 | [0.77 - 1.17] | |||
Uninsured
| 0.36 | 0.40 | 0.35 | 1.12 | [0.89 - 1.41] | |||
Urban
| 0.44 | 0.44 | 0.45 | 0.99 | [0.80 - 1.21] | |||
County/town
| 0.18 | 0.15 | 0.18 | 0.83 | [0.54 - 1.27] | |||
Village
| 0.38 | 0.41 | 0.37 | 1.10 | [0.88 - 1.37] | |||
Married
| 0.97 | 0.97 | 0.97 | 1.00 | [0.97 - 1.04] | |||
Current smoker
| 0.26 | 0.34 | 0.24 | 1.41 | [1.08 - 1.84] | |||
Duration of DM (months) | 67.30 | 64.42 | 4.69 | 9.69 | 77.47 | 63.78 | -72.78 | [-83.61 - -61.94] |
BMI (kg/m2) | 23.90 | 4.00 | 24.78 | 5.26 | 23.76 | 3.74 | 1.02 | [0.27 - 1.77] |
Fast. blood sugar (mg/dl) | 163.95 | 66.28 | 186.60 | 70.91 | 160.30 | 64.90 | 26.30 | [13.88 - 38.72] |
Triglyceride mg/dl | 201.88 | 209.51 | 242.83 | 265.11 | 195.37 | 198.67 | 47.46 | [8.88 - 86.03] |
Total cholesterol mg/dl | 175.18 | 44.80 | 186.16 | 47.25 | 173.43 | 44.17 | 12.73 | [4.50 - 20.96] |
Plasma LDL-C mg/dl | 103.59 | 39.81 | 109.19 | 33.72 | 102.72 | 40.62 | 6.47 | [-1.00 - 13.95] |
AST IU/L | 27.79 | 26.05 | 37.66 | 48.13 | 26.21 | 20.02 | 11.45 | [6.71 - 16.19] |
ALT IU/L | 30.52 | 30.51 | 40.87 | 36.31 | 28.86 | 29.16 | 12.01 | [6.45 - 17.58] |
Creatinine mg/dl | 0.87 | 0.55 | 0.79 | 0.21 | 0.88 | 0.58 | -0.10 | [-0.20 - 0.003] |
BUN mg/dl | 15.87 | 7.77 | 14.55 | 5.15 | 16.08 | 8.10 | -1.53 | [-2.96 - -0.11] |
eGFR ml/min/1.73 M2 | 101.39 | 34.54 | 111.05 | 31.22 | 99.84 | 34.81 | 11.22 | [4.90 - 17.53] |
HbA1c % | 8.70 | 2.82 | 10.40 | 2.22 | 8.41 | 2.81 | 1.99 | [1.48 - 2.50] |
Complications upon diagnosis
| 0.32 | 0.41 | 0.30 | 1.35 | [1.07 - 1.69] | |||
Chronic complications
| 0.83 | 0.75 | 0.84 | 0.89 | [0.80 - 0.98] | |||
UKPDS CHD risk | 24.63 | 0.69 | 18.77 | 1.39 | 25.59 | 20.97 | -6.82 | [-10.66 - -2.97] |
UKPDS stroke risk | 15.00 | 0.68 | 4.34 | 0.54 | 16.69 | 0.77 | -12.35 | [-16.16 - -8.55] |
Drug expenditures | 3,100.82 | 4,588.62 | 2336.80 | 2770.30 | 3231.51 | 4810.51 | -894.71 | [-1735.13 - -54.30] |
Diagnostic test expenditures | 2,106.74 | 1,131.80 | 1976.92 | 873.45 | 2132.77 | 1163.81 | -155.85 | [-362.73 - 51.02] |
Surgical expenditures | 96.57 | 456.74 | 57.44 | 287.07 | 103.12 | 478.82 | -45.67 | [-129.50 - 38.16] |
Hospital room expenditures | 693.40 | 1,039.34 | 622.01 | 931.19 | 706.59 | 1056.48 | -84.58 | [-275.30 - 106.14] |
Therapy expenditures | 309.89 | 1,625.24 | 176.82 | 359.85 | 332.10 | 1746.37 | -155.28 | [-453.59 - 143.04] |
Medical material expenditures | 596.51 | 2,297.50 | 344.97 | 386.96 | 638.50 | 2471.13 | -293.53 | [-715.04 - 127.98] |
Total expenditures | 6,903.93 | 8,328.53 | 5473.80 | 3956.79 | 7135.94 | 8815.95 | -1,662.14 | [-3181.44 - -142.84] |
Panel B: Shandong Provincial Hospital
| ||||||||
(N = 911) | (N = 62) | (N = 849) | ||||||
Patient age | 61.61 | 12.32 | 52.76 | 15.47 | 62.25 | 11.81 | -9.49 | [-12.62 - -6.37] |
Female
| 0.50 | 0.44 | 0.50 | 0.88 | [0.66 - 1.17] | |||
< High School
|
Variable not available for Shandong data
| |||||||
Insured
| 0.09 | 0.06 | 0.10 | 0.60 | [0.22 - 1.64] | |||
Semi-insured
| 0.69 | 0.44 | 0.71 | 0.62 | [0.47 - 0.82] | |||
Uninsured
| 0.21 | 0.50 | 0.19 | 2.63 | [1.98 - 3.50] | |||
Urban
| 0.88 | 0.71 | 0.89 | 0.80 | [0.68 - 0.94] | |||
Rural
| 0.12 | 0.29 | 0.11 | 2.64 | [1.71 - 4.07] | |||
Married
| 0.94 | 0.98 | 0.93 | 1.05 | [1.01 - 1.10] | |||
Current smoker
| 0.18 | 0.16 | 0.19 | 0.84 | [0.47 - 1.51] | |||
Duration of DM (months) | 120.19 | 84.49 | 3.14 | 2.27 | 128.74 | 81.15 | -125.60 | [-145.83 - -105.36] |
BMI (kg/m2) | 25.30 | 3.98 | 25.47 | 4.66 | 25.29 | 3.92 | 0.18 | [-0.93 - 1.30] |
Fasting blood glucose (mg/dl) | 157.28 | 44.21 | 159.69 | 38.80 | 157.10 | 44.60 | 2.59 | [-7.52 - 12.70] |
Plasma triglyceride mg/dl | 155.04 | 133.11 | 166.06 | 158.28 | 154.22 | 131.13 | 11.84 | [-28.53 - 52.21] |
Plasma total cholesterol mg/dl | 202.32 | 49.85 | 205.76 | 37.06 | 202.06 | 50.68 | 3.70 | [-6.13 - 13.54] |
Plasma LDL-C mg/dl | 133.72 | 377.89 | 122.95 | 27.70 | 134.52 | 391.72 | -11.57 | [-38.81 - 15.67] |
AST IU/L | 23.79 | 26.50 | 30.09 | 39.57 | 23.33 | 25.26 | 6.76 | [-3.24 - 16.76] |
ALT IU/L | 22.53 | 33.10 | 30.03 | 43.38 | 21.99 | 32.19 | 8.04 | [-2.97 - 19.05] |
Creatinine mg/dl | 1.01 | 0.59 | 0.86 | 0.19 | 1.02 | 0.61 | -0.16 | [-0.22 - -0.10] |
BUN mg/dl | 17.44 | 12.29 | 14.41 | 5.81 | 17.67 | 12.62 | -3.26 | [-4.94 - -1.58] |
eGFR ml/min/1.73 M2 |
Variable not available for Shandong Data
| |||||||
HbA1c % | 10.05 | 2.58 | 11.03 | 2.93 | 9.98 | 2.54 | 1.05 | [0.38 - 1.71] |
Complication upon diagnosis
|
Variable not available for Shandong data
| |||||||
Chronic complications
| 0.90 | 0.68 | 0.91 | 0.75 | [0.63 - 0.89] | |||
UKPDS CHD risk |
Variable not available for Shandong data
| |||||||
UKPDS stroke risk |
Variable not available for Shandong data
| |||||||
Drug expenditures | 12,043.97 | 9,701.05 | 7,330.60 | 4,718.68 | 12,388.17 | 9,881.62 | -5,057.57 | [-7541.92 - -2573.21] |
Diagnostic test expenditures | 1,431.07 | 1,165.98 | 1,431.32 | 1,256.91 | 1,430.26 | 1,159.81 | 1.06 | [-300.13 - 302.26] |
Surgical expenditures | 32.00 | 235.56 | 33.87 | 266.70 | 31.86 | 233.30 | 2.01 | [-58.84 - 62.86] |
Hospital room expenditures | 935.89 | 1,642.43 | 574.35 | 356.56 | 962.29 | 1,695.71 | -387.94 | [-811.48 - 35.60] |
Therapy expenditures | 2,587.25 | 3,869.05 | 1,926.57 | 1,115.99 | 2,635.50 | 3,992.51 | -708.93 | [-1707.36 - 289.49] |
Medical material expenditures |
Variable not available for Shandong data
| |||||||
Total expenditures | 17,294.27 | 13,118.62 | 11,478.48 | 5,945.20 | 17,718.98 | 13,397.19 | -6,240.50 | [-9605.00 - -2876.00] |
Methods
Results
Descriptive statistics
Descriptive statistics: newly diagnosed vs. treatment-experienced inpatients
Multivariate analysis: differences in socioeconomic and clinical characteristics of newly diagnosed and treatment-experienced patients
Sir Run Run Shaw Hospital | Shandong Provincial Hospital | |||||
---|---|---|---|---|---|---|
New admissions only† | All observations | New admissions only† | ||||
(1) | (2) | (3) | (4) | (5) | (6) | |
Dependent variable: first diagnosis of T2D within 6 months of inpatient admission (=1 if yes)
| ||||||
Patient age | -0.46 | -0.39 | -0.26 | -0.26 | -0.28 | -0.28 |
[-0.64 - -0.28)] | [-0.57 - -0.21] | [-0.38 - -0.14] | [-0.38 - -0.14] | [-0.42 - -0.15] | [-0.41 - -0.15] | |
Female
| -6.37 | -5.64 | -2.54 | -2.44 | -2.66 | -2.56 |
[-11.2 - -1.52] | [-10.4 - -0.86] | [-6.23 - 1.15] | [-6.13 - 1.25] | [-6.80 - 1.48] | [-6.70 - 1.58] | |
< High school
| 6.02 | 5.41 | Not available | Not available | Not available | Not available |
[1.59 - 10.4)] | [1.05 - 9.77] | |||||
Insurance status | ||||||
Insured | 1.99 | 2.53 | -2.03 | -2.15 | -1.51 | -1.52 |
[-4.98 - 8.95] | [-4.51 - 9.58] | [-7.11 - 3.05] | [-7.15 - 2.85] | [-8.06 - 5.04] | [-8.07 - 5.03] | |
Semi-insured | -0.038 | 0.8 | -6.80 | -6.77 | -7.00 | -6.94 |
[-4.89 - 4.82] | [-3.99 - 5.60] | [-12.8 - -0.84] | [-12.7 - -0.792] | [-13.4 - -0.61] | [-13.3 - -0.53] | |
Residence | ||||||
Urban | 2.35 | 2.64 | -0.578 | -0.66 | -0.97 | -1.07 |
[-3.00 - 7.71] | [-2.64 - 7.93] | [-5.75 - 4.60] | [-6.07 - 4.75] | [-6.93 - 4.99] | [-7.09 - 4.95] | |
County/town | -2.29 | -0.71 | Not available | Not available | Not available | Not available |
[-8.08 - 3.51] | [-6.74 - 5.31] | |||||
Smoking history | -0.76 | -0.46 | -1.84 | -1.73 | -2.14 | -2.02 |
[-5.84 - 4.32] | [-5.50 - 4.59] | [-5.31 - 1.63] | [-5.24 - 1.78] | [-6.08 - 1.80] | [-6.00 - 1.96] | |
Serum glucose | ||||||
HbA1c % | 1.95 | 0.56 | 0.60 | |||
[1.35 - 2.56] | [0.01 - 1.12] | [-0.024 - 1.23] | ||||
HbA1c% > 10% | 21.4 | 3.07 | 3.40 | |||
[15.1 - 27.7] | [-0.144 - 6.28] | [-0.21 - 7.01] | ||||
Year fixed effects | Included | Included | Included | Included | Included | Included |
Observations | 900 | 900 | 822 | 822 | 741 | 741 |
Association between HbA1c scores at admission and socioeconomic/clinical characteristics
Sir Run Run Shaw Hospital | Shandong Provincial Hospital | |||||
---|---|---|---|---|---|---|
New admissions only† | New admissions only† | All admissions | ||||
VARIABLES | (1) | (2) | (3) | (4) | (5) | (6) |
Dependent variable: HbA1c
| ||||||
Demographic | ||||||
Patient age | -0.021 | -0.019 | -0.008 | -0.0094 | -0.011 | -0.014 |
[-0.034 - -0.0073] | [-0.033 - -0.0061] | [-0.024 - 0.0078] | [-0.026 - 0.0072] | [-0.026 - 0.0045] | [-0.03 - 0.002] | |
Married | Not included | 0.23 | Not included | -0.33 | Not included | -0.49 |
[-1.91 - -0.82] | ||||||
[-0.49 - 0.95] | [-1.1 - 0.44] | [-1.19 - 0.22] | ||||
Female | -0.37 | -0.28 | 0.21 | 0.19 | 0.16 | 0.13 |
[-0.74 - 0.012] | [-0.66 - 0.095] | [-0.21 - 0.63] | [-0.23 - 0.62] | [-0.20 - 0.53] | [-0.24 - 0.50] | |
Urban | -0.37 | -0.4 | -0.47 | -0.47 | -0.39 | -0.38 |
[-0.73 - -0.018] | [-0.74 - -0.053] | [-1.23 - 0.30] | [-1.23 - 0.30] | [-1.14 - 0.35] | [-1.13 - 0.36] | |
County/town | -0.13 | -0.082 | Not available | Not available | Not available | Not available |
[-0.86 - 0.61] | [-0.83 - 0.67] | |||||
< High school | -0.085 | -0.14 | Not available | Not available | Not available | Not available |
[-0.55 - 0.38] | [-0.59 - 0.32] | |||||
Unemployed | -0.32 | -0.28 | 0.011 | 0.014 | 0.063 | 0.064 |
[-0.91 - 0.27] | [-0.86 - 0.30] | [-0.82 - 0.84] | [-0.82 - 0.85] | [-0.74 - 0.87] | [-0.74 - 0.87] | |
Past treatment | ||||||
Oral agents | Not included | -1.26 | Not available | Not available | Not available | Not available |
[-1.71 - -0.81] | ||||||
Insulin | Not included | -1.37 | Not available | Not available | Not available | Not available |
[-0.49 - 0.95] | [-1.1 - 0.44] | [-1.19 - 0.22] | ||||
Insurance | ||||||
Insured | -0.58 | -0.59 | -1.62 | -1.62 | -1.74 | -1.74 |
[-1.02 - -0.15] | [-1.01 - -0.17] | [-2.62 - -0.62] | [-2.62 - -0.62] | [-2.68 - -0.80] | [-2.68 - -0.80] | |
Semi-insured | -0.053 | -0.0018 | -0.41 | -0.41 | -0.45 | -0.44 |
[-0.42 - 0.31] | [-0.37 - 0.36] | [-1.20 - 0.37] | [-1.20 - 0.37] | [-1.21 - 0.32] | [-1.20 - 0.32] | |
Clinical
| ||||||
Smoker | -0.083 | -0.031 | 0.24 | 0.23 | 0.21 | 0.19 |
[-0.44 - 0.29] | [-0.39 - 0.33] | [-0.22 - 0.69] | [-0.22 - 0.69] | [-0.26 - 0.68] | [-0.28 - 0.66] | |
Duration/months | 0.0015 | 0.0039 | -0.0017 | -0.0017 | -0.0016 | -0.0015 |
[-0.0072 - 0.010] | [-0.0048 - 0.013] | [-0.0041 - 0.00067] | [-0.0042 - 0.00070] | [-0.0038 - 0.00056] | [-0.0037 - 0.00069] | |
Family history | Not included | -0.33 | Not included | -0.0036 | Not included | -0.10 |
[-0.74 - 0.078] | [-0.38 - 0.37] | [-0.45 - 0.24] | ||||
Year fixed effects
| Included | Included | Included | Included | Included | Included |
Observations | 899 | 898 | 808 | 808 | 910 | 910 |
R-squared | 0.04 | 0.08 | 0.05 | 0.05 | 0.06 | 0.06 |