Health care utilization and expenditures of persons with diabetes comorbid with anxiety disorder: a national population-based cohort study.
OBJECTIVE
The aim of this study was to investigate and compare health care utilization and expenditures between persons with diabetes comorbid with and without anxiety disorder in Taiwan.


METHODS
Health care utilization and expenditures among persons with diabetes with and without comorbid anxiety disorder in the period 2000-2004 were examined using the Taiwan's National Health Insurance claims data. Health care utilization included outpatient visits and use of hospital inpatient services, while expenditures included outpatient, inpatient and total medical expenditures. General estimation equation (GEE) models were used to analyze the factors associated with outpatient visits and expenditures, and multiple logistic regression analysis was applied to identify factors associated with hospitalization.


RESULTS
In the study period, the average number of annual outpatient visits was 43.11-50.37 and 29.82-31.42 for persons with diabetes comorbid with anxiety disorder and for those without anxiety disorder, respectively. The average annual total expenditure was NT$74,875-92,781 and NT$63,764-81,667, respectively. Controlling for covariates, the GEE models revealed that age and time were associated with outpatient visits. Income and time factor were associated with total expenditure.


CONCLUSIONS
Health care utilization and expenditures for persons with diabetes with comorbid anxiety disorder are significantly higher than those without anxiety disorder. The factors associated with health care utilization and expenditures are age, income and time.
Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Chun-Jen
CJ
Huang
Department of Healthcare Administration and Medical Informatics, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan.
Herng-Chia
HC
Chiu
Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.
Hui-Min
HM
Hsieh
Department of Psychiatry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Ju-Yu
JY
Yen
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Mei-Hsuan
MH
Lee
Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Kao-Ping
KP
Chang
Division of Secretary, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.
Chih-Yi
CY
Li
Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan. Electronic address: chua.lin@msa.hinet.net.
Ching-Hua
CH
Lin
D000328:Adult; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D001008:Anxiety Disorders / Q000191:economics / Q000453:epidemiology*; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000191:economics / Q000453:epidemiology*; D005260:Female; D005102:Health Expenditures; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology
Anxiety disorder; Diabetes; Expenditure; Health care utilization