title: Life Expectancy and Lifetime Health Care Expenditures for Type 1 Diabetes: A Nationwide Longitudinal Cohort of Incident Cases Followed for 14 Years.
abstract: OBJECTIVE
  To assess additional life expectancy (LE), expected years of life lost , and lifetime health care expenditures after type 1 diabetes diagnosis, stratified by sex and age of first diagnosis (early: 0-12 years; late: 13-40 years).
  
  
  METHODS
  A longitudinal cohort of patients with diabetes was constructed from Taiwan's National Health Insurance Research Database of 1999 to 2012. The survival functions for diabetic patients and age- and sex-matched general population were estimated by using a semiparametric extrapolation method with annual life tables. The average monthly health care expenditures were multiplied by the corresponding monthly survival rates and summed to calculate the lifetime health care expenditures. Cox proportional hazard models were constructed to corroborate the effects of sex and age, after being adjusted for comorbidities, complications, and calendar years.
  
  
  RESULTS
  A total of 2386 cases (45% early diagnosis, 49% males) were identified. An additional LE after diabetes diagnosis was 45.12 years, with an estimated 17.63 years of life lost. The predicted total and diabetes-related lifetime costs were $56,939 and $102,140, respectively. Early diagnosed patients had a longer LE and lower health care spending compared with those of late-diagnosed patients. Male patients had a shorter LE and a higher expected years of life lost than the female patients, which corresponded to lower lifetime costs for the former. The Cox model results for overall mortality corroborated these trends.
  
  
  CONCLUSIONS
  Early detection of type 1 diabetes and sex-specific strategies would probably improve long-term health outcomes and save on the cost of diabetes care.
authors.affiliation: Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Electronic address: huangtz@mail.ncku.edu.tw.
authors.forename: Huang-Tz
authors.initials: HT
authors.lastname: Ou
authors.affiliation: Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Chen-Yi
authors.initials: CY
authors.lastname: Yang
authors.affiliation: Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
authors.affiliation: Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.
authors.forename: Jing-Shiang
authors.initials: JS
authors.lastname: Hwang
authors.affiliation: Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Jin-Shang
authors.initials: JS
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000191:economics* / Q000401:mortality*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008017:Life Expectancy; D008137:Longitudinal Studies; D008297:Male; D012042:Registries; D012737:Sex Factors; D015996:Survival Rate; D013624:Taiwan; D055815:Young Adult
keywords: expected years of life lost; life expectancy; lifetime health care expenditures; semiparametric extrapolation method; type 1 diabetes