title: How do type 2 diabetes mellitus-related chronic complications impact direct medical cost in four major cities of urban China?
abstract: OBJECTIVE
  The purpose of this study was to evaluate the direct medical costs of type 2 diabetes mellitus with or without complications, and to determine the economic impact of complications on type 2 diabetic patients.
  
  
  METHODS
  We performed a cross-sectional study of prevalent type 2 diabetes carried out in four major cities of China. The study populations were 1530 outpatients and 524 inpatients from clinics or wards of a total of 20 hospitals, using a two-phase subject enrollment process, by face-to-face interview with a unique questionnaire.
  
  
  RESULTS
  The annual direct medical cost per patient was estimated to be 4800 Chinese Yuan (CNY) in median or 10,164 CNY in mean. There is a difference between annual direct medical costs for patients with or without complications (6056 vs. 3583 CNY; P < 0.001). It is also significantly different for the pay-out-of-pocket proportions (P = 0.015) between the patients with (44.6%) and without complications (40.4%). The direct medical cost varied significantly among the four cities (P < 0.001). Patients who simultaneously suffered microvascular and macrovascular diseases had higher direct medical cost (7600) than those with macrovascular (6000) (P = 0.012) and microvascular disease (5364) (P < 0.001), and those without both (3600) (P < 0.001). The correlation was statistically significant between the number of complications and direct medical costs (P < 0.001).
  
  
  CONCLUSIONS
  The high economic burden raised by diabetes and its complications challenges the Chinese health-care system. It implicates an urgent need of intervention to prevent the development of long-term complications among the diabetic population, especially on the development of complications in high-cost body system.
authors.affiliation: School of Public Health, Fudan University, Shanghai, China.
authors.forename: Weibing
authors.initials: W
authors.lastname: Wang
authors.forename: Chao Wei
authors.initials: CW
authors.lastname: Fu
authors.forename: Chang Yu
authors.initials: CY
authors.lastname: Pan
authors.forename: Weiqing
authors.initials: W
authors.lastname: Chen
authors.forename: Siyan
authors.initials: S
authors.lastname: Zhan
authors.forename: Rongsheng
authors.initials: R
authors.lastname: Luan
authors.forename: Alison
authors.initials: A
authors.lastname: Tan
authors.forename: Zhaolan
authors.initials: Z
authors.lastname: Liu
authors.forename: Biao
authors.initials: B
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D002947:Cities; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000191:economics* / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000191:economics / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult