Yu, D ORCID: https://orcid.org/0000-0002-8449-7725, Cai, Y, Graffy, J, Holman, D, Zhao, Z and Simmons, D (2020) Association between systolic blood pressure and cardiovascular inpatient cost moderated by peer-support intervention among type 2 diabetes: two cohorts study. Canadian Journal of Diabetes.

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Abstract

Objective
People with type 2 diabetes and increased systolic blood pressure (SBP) are at high risk of cardiovascular diseases (CVD). We aimed to investigate the association between CVD related hospital payments and SBP and test whether it is influenced by diabetes peer-support.

Methods
Two cohorts comprising people with type 2 diabetes were included. The first cohort includes 4,704 patients with type 2 diabetes assessed between 2008-2009 from 18 general practices in Cambridgeshire and followed up to 2009-2011. The second cohort comprises 1,121 patients with type 2 diabetes from post-trial follow-up data, recruited between 2011-2012 and followed up to 2015. The SBP was measured at baseline. Inpatient payments for CVD hospitalization within 2 years since baseline was the main outcome. The impact of 1:1, group or combined diabetes peer support and usual care were investigated in the second cohort. Adjusted mean CVD inpatient payments per person were estimated using a two-part model after adjusting for baseline characteristics.

Results
A `hockey-stick’ relationship between baseline SBP and estimated CVD inpatient payment was identified in both two cohorts, with a threshold at 133-141 mmHg, suggesting increased payments for patients with SBP below and above the threshold. The combined peer-support intervention altered the above association, with no increased payment with SBP above the threshold, and payment slightly decreased with SBP beyond the threshold.

Conclusion
SBP maintained between 133-141 mmHg is associated with the lowest CVD disease management costs for patients with Type 2 diabetes. Combined peer-support intervention could significantly decrease CVD related hospital payments.

Item Type: Article
Additional Information: The final accepted version of this article and all relevant information, including copyrights, can be found online at; https://www.sciencedirect.com/science/article/pii/S1499267120302318?via%3Dihub
Uncontrolled Keywords: systolic blood pressure, hospitalization, health payment, two-part model
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine
R Medicine > RC Internal medicine > RC660 Diabetes
R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Related URLs:
Depositing User: Symplectic
Date Deposited: 12 Aug 2020 14:38
Last Modified: 14 Aug 2020 10:39
URI: https://eprints.keele.ac.uk/id/eprint/8536

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