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ABSTRACT: We evaluated the factors associated with inpatient costs including total costs, pharmaceutical costs and laboratory costs for diabetes-related admissions.
Using data for 960 adult patients admitted between May 2005 and April 2008 with a primary or secondary diagnosis of type 2 diabetes mellitus (DM) at Sir Run Run Shaw Hospital affiliated with Zhejiang University Medical School (SRRSH) in Hangzhou, China, we evaluate the association between patient characteristics and inpatient costs with multivariable regression analyses.
Total inpatient costs were positively associated with age, higher UKPDS stroke risk score, and presence of any complication. A regression that included patient socioeconomic and clinical characteristics explained 21.5% of the variation in total inpatient costs; regression estimates indicate that patients with coronary artery disease, retinopathy, nephropathy, neuropathy, and diabetic foot had inpatient costs that were respectively 93.7%, 14.0%, 17.5%, 11.5% and 89.0% higher than otherwise similar patients without those complications. Pharmaceutical costs did not differ by insurance coverage. Insured patients spent 7-16% more on laboratory tests than otherwise similar patients did.
Clinical factors, especially presence of diabetes-related complications, appear to be the primary determinants of variation in inpatient costs for patients with type 2 DM in China. To mitigate the health costs increases associated with China's DM epidemic, policymakers should focus on cost-effective ways to manage patients in outpatient settings to prevent the complications associated with diabetes.
Experimental and Clinical Endocrinology & Diabetes 01/2012; 120(1):35-44. · 1.69 Impact Factor
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J D Goldhaber-Fiebert, H Li,
S Ratanawijitrasin,
S Vidyasagar,
X Y Wang,
S Aljunid,
N Shah,
Z Wang,
S Hirunrassamee,
K L Bairy,
J Wang,
S Saperi,
A M Nur,
K Eggleston
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ABSTRACT: The prevalence of Type 2 diabetes mellitus (DM) has grown rapidly, but little is known about the drivers of inpatient spending in low- and middle-income countries. This study aims to compare the clinical presentation and expenditure on hospital admission for inpatients with a primary diagnosis of Type 2 DM in India, China, Thailand and Malaysia.
We analysed data on adult, Type 2 DM patients admitted between 2005 and 2008 to five tertiary hospitals in the four countries, reporting expenditures relative to income per capita in 2007.
Hospital admission spending for diabetic inpatients with no complications ranged from 11 to 75% of per-capita income. Spending for patients with complications ranged from 6% to over 300% more than spending for patients without complications treated at the same hospital. Glycated haemoglobin was significantly higher for the uninsured patients, compared with insured patients, in India (8.6 vs. 8.1%), Hangzhou, China (9.0 vs. 8.1%), and Shandong, China (10.9 vs. 9.9%). When the hospital admission expenditures of the insured and uninsured patients were statistically different in India and China, the uninsured always spent less than the insured patients.
With the rising prevalence of DM, households and health systems in these countries will face greater economic burdens. The returns to investment in preventing diabetic complications appear substantial. Countries with large out-of-pocket financing burdens such as India and China are associated with the widest gaps in resource use between insured and uninsured patients. This probably reflects both overuse by the insured and underuse by the uninsured.
Diabetic Medicine 01/2010; 27(1):101-8. · 2.90 Impact Factor
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ABSTRACT: In this paper series expansion is developed for the probability distribution function (PDF) and the cumulative distribution function (CDF) of an indefinite Hermitian quadratic form in complex random variables with Gaussian mixture distribution. The moment generating function is inverted by contour integration using the residue theorem. The series expansion result is computationally efficient. Bit error rate (BER) calculation, involving quadratic form in Gaussian mixture variables, in wireless relay network employing BPSK transmission is presented as an application.
Signal Processing Advances in Wireless Communications, 2005 IEEE 6th Workshop on; 07/2005
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ABSTRACT: The aim of this study was to investigate quantitative mRNA expression of matrix metalloproteinases MMP-1, MMP-2, MMP-9, and their inhibitors, the tissue inhibitors of metalloproteinases TIMP-1, TIMP-2 and TIMP-3, in vaginal wall tissue from women with stress urinary incontinence compared to continent controls. Vaginal wall tissues were obtained from 7 women with stress urinary incontinence/severe pelvic prolapse and 15 continent controls. RNA was then extracted and quantified. Quantitative competitive reverse transcription (QC-RT-PCR) was carried out with oligonucleotide primers to quantify MMP-1, MMP-2, MMP-9, TIMP-1, TIMP-2 and TIMP-3 mRNA expression. Stress continent women demonstrated a significant decrease in TIMP-1 and mRNA expression (P = 0.03). There was no difference in TIMP-2, TIMP-3, MMP-2 or MMP-9 mRNA expression between stress incontinent women and controls. However, MMP-1 mRNA expression was significantly increased (P = 0.05) in the incontinent group and the MMP-1/TIMP-1 ratio (P = 0.04) was consistent with increased collagen degradation in the stress incontinence. Stress incontinent women demonstrated an increase in MMP-1 mRNA expression and a decrease in the inhibitor TIMP-1 mRNA expression. Both these findings are consistent with increased collagen breakdown as a pathologic etiology of incontinence.
International Urogynecology Journal 02/2002; 13(2):80-7; discussion 87. · 1.83 Impact Factor
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Drug Metabolism Reviews 12/1997; 29(4):1107-27. · 6.40 Impact Factor
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ABSTRACT: To identify new dimerization partners for the aromatic hydrocarbon receptor nuclear translocator (Arnt), we used its N-terminal region (amino acids 1-470) as a target in a two-hybrid screening procedure, and we cloned the murine form of hypoxia-inducible factor 1alpha (HIF1alpha). Sequence comparisons reveal substantial identity between mouse and human HIF1alpha. Hypoxia induces a 10-fold accumulation of phosphoglycerate kinase 1 mRNA in wild type mouse hepatoma (Hepa 1c1c7) cells; the induction mechanism is Arnt dependent because induction does not occur in Arnt-defective cells. Furthermore, induction of phosphoglycerate kinase 1 mRNA requires Arnt's N-terminal region, which mediates DNA binding and heterodimerization; in contrast, induction does not require Arnt's C-terminal region, which mediates transactivation. We also show that a GAL4-HIF1alpha fusion protein transactivates a GAL4-dependent gene in the absence of Arnt, that HIF1alpha's transactivation capability is inducible by hypoxia, and that both hypoxia responsiveness and transactivation capability reside within the C-terminal 83 amino acids of HIF1alpha. Our findings generate new insights into the mechanism by which Arnt and HIF1alpha induce transcription in response to hypoxia.
Journal of Biological Chemistry 09/1996; 271(35):21262-7. · 4.77 Impact Factor
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ABSTRACT: We cloned from mouse hepatoma cells a cDNA which encodes the Ah receptor nuclear translocator (Arnt). Sequence comparisons reveal 89% nucleotide and 92% amino acid identity between mouse and human Arnt. Transfection of the cDNA into Arnt-defective mouse hepatoma cells fully restores their responsiveness to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), indicating that the cDNA encodes a functional Arnt protein. Transfection of the cDNA into wild type mouse hepatoma cells increases the magnitude, but not the sensitivity, of the transcriptional response to TCDD. Analyses of mutants indicate that Arnt has a modular organization. The unit that mediates both heterodimerization with the liganded Ah receptor and DNA recognition is functionally distinct from the unit that mediates transcriptional activation. A 96-amino acid, C-terminal domain of Arnt, which includes a glutamine-rich region, confers transcriptional activation capability upon the protein.
Journal of Biological Chemistry 12/1994; 269(45):28098-105. · 4.77 Impact Factor
