The Monthly Cycle of Hypoglycemia: An Observational Claims-based Study of Emergency Room Visits, Hospital Admissions, and Costs in a Commercially Insured Population.
The Monthly Cycle of Hypoglycemia: An Observational Claims-based Study of Emergency Room Visits, Hospital Admissions, and Costs in a Commercially Insured Population.
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DOI：
10.1097/mlr.0000000000000728
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发表时间：
2017-07
期刊：
影响因子：
3
通讯作者：
Seligman H
中科院分区：
文献类型：
--
作者：
Basu S;Berkowitz SA;Seligman H
补充数字内容可在文本中找到。多付款人倡议试图通过将初级保健患者与社会服务联系起来，解决健康的社会决定因素，如粮食不安全。目前尚不清楚这些社会决定因素是否有助于避免短期保健费用。我们试图量化低收入美国人每月月底低血糖风险增加的成本和缓解因素，这一现象与食物预算耗尽有关。我们使用了2004年至2015年期间595，770名19至64岁的商业保险美国成年人的索赔数据，以估计每个月最后一周与前几周相比因低血糖而急诊室就诊和住院的风险和费用。虽然家庭收入高于全国中位数的人没有经历低血糖的月周期，但收入低于全国中位数的人在每个月的最后一周与前几周相比，急诊室就诊或住院低血糖的比值比为1.07（95%置信区间，1.02-1.12; P=0.005）。在2009年至2013年联邦营养计划获益增加期间，月末低血糖风险降低至统计学不显著。在商业保险的非老年成年人中消除低血糖的月周期，预计每年可避免急诊和住院费用5410万美元（95%置信区间，0.8 - 204.0美元）。解决低收入人群中低血糖风险的月底增加可能会避免急诊科就诊和住院治疗的大量费用。
Supplemental Digital Content is available in the text. Multipayer initiatives have sought to address social determinants of health, such as food insecurity, by linking primary care patients to social services. It remains unclear whether such social determinants contribute to avoidable short-term health care costs. We sought to quantify costs and mitigating factors for the increased risk of hypoglycemia at the end of each month among low-income Americans, a phenomenon related to exhaustion of food budgets. We used claims data on 595,770 commercially insured American adults aged 19 through 64 years old from 2004 through 2015 to estimate the risks and costs of emergency room visits and inpatient hospitalizations for hypoglycemia during the last week of each month versus prior weeks. Although persons with household incomes greater than the national median did not experience a monthly cycle of hypoglycemia, those with incomes less than the national median had an odds ratio of 1.07 (95% confidence interval, 1.02–1.12; P=0.005) for emergency room visits or inpatient hospitalizations for hypoglycemia during the last week of each month, compared with earlier weeks. The risk of end-of-the-month hypoglycemia was mitigated to statistical insignificance during a period of increased federal nutrition program benefits from 2009 through 2013. Eliminating the monthly cycle of hypoglycemia among commercially insured nonelderly adults would be expected to avert $54.1 million per year (95% confidence interval, $0.8–$204.0) in emergency department and inpatient hospitalization costs. Addressing the end-of-the-month increase in hypoglycemia risk among lower-income populations may avert substantial costs from emergency department visits and inpatient hospitalizations.