title: Do physicians with diabetes have differences in dialysis use and survival than other patients with diabetes.
abstract: OBJECTIVE
  To assess whether the increased knowledge and resources available to physicians led to differences in dialysis and survival rates between physicians and non-physician patients with diabetes.
  
  
  METHODS
  All newly diagnosed (1997-2009) type 2 diabetes patients aged ≥35 years from the National Health Insurance Program of Taiwan database were included. After propensity score matching (1:10), we estimated the relative risk of dialysis and death using Cox proportional hazards model adjusted for demographic characteristics and comorbidities.
  
  
  RESULTS
  Physicians with diabetes were more likely to start dialysis than general patients, with a 48% increased hazard risk (HR) (P=0.006). Physicians with diabetes had significantly lower risk of death (HR: 0.88; P=0.025). However, those requiring dialysis had a non-significant increased risk of death (HR: 1.19). There was an increased HR for death in older physicians (HR: 1.81; P<0.001) and those with cancer or catastrophic illness. The HR of dialysis (7.89; P<0.0001) increased dramatically with increasing Charlson Comorbidity Index scores.
  
  
  CONCLUSIONS
  Physicians with DM survived longer than other patients with diabetes, likely benefiting from their professional resources in disease control and prevention. Nonetheless, they displayed no advantage from their medical backgrounds compared with the general patients if they developed end stage renal disease.
authors.affiliation: Department of Health Care Management, National Taipei University of Nursing and Health Sciences, No. 89, Nei-Chiang Street, Taipei 10845, Taiwan, ROC; Department of Healthcare Administration, Asia University, 500, Lioufeng Road, Wufeng, Taichung 41354, Taiwan, ROC.
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Chiou
authors.affiliation: Department of Healthcare Administration, Asia University, 500, Lioufeng Road, Wufeng, Taichung 41354, Taiwan, ROC.
authors.forename: Pei-Tseng
authors.initials: PT
authors.lastname: Kung
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
authors.forename: James M
authors.initials: JM
authors.lastname: Naessens
authors.affiliation: Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan, ROC.
authors.forename: Kuang-Hua
authors.initials: KH
authors.lastname: Huang
authors.affiliation: Department of Healthcare Administration, Asia University, 500, Lioufeng Road, Wufeng, Taichung 41354, Taiwan, ROC.
authors.forename: Yu-Chia
authors.initials: YC
authors.lastname: Chang
authors.affiliation: Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan, ROC.
authors.forename: Yueh-Hsin
authors.initials: YH
authors.lastname: Wang
authors.affiliation: Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan, ROC. Electronic address: wtsai@mail.cmu.edu.tw.
authors.forename: Wen-Chen
authors.initials: WC
authors.lastname: Tsai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000401:mortality / Q000523:psychology; D003928:Diabetic Nephropathies / Q000401:mortality* / Q000628:therapy; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality* / Q000706:statistics & numerical data*; D012307:Risk Factors; D015996:Survival Rate; D013624:Taiwan
keywords: Diabetes; Dialysis; Physician with diabetes; Survival analysis