Journal Article

Cardiovascular and renal diseases in type 2 diabetes patients: 5-year cumulative incidence of the first occurred manifestation and hospitalization cost: a cohort within the French SNDS nationwide claims database

Lassalle, Régis, Moore, Nicholas, Guiard, Estelle, Thomas-Delecourt, Florence, Dureau-Pournin, Caroline, Bernard, Marie-Agnès, Sakr, Dunia, Blin, Patrick, Jourdain, Patrick, Droz-Perroteau, Cécile, Zaoui, Philippe, Bineau, Sébastien, Joubert, Michael

2024

Overview

Background Myocardial infarction (MI), stroke, peripheral arterial disease (PAD), heart failure (HF) and chronic kidney disease (CKD) are common cardiovascular renal diseases (CVRD) manifestations for type 2 diabetes. The objective was to estimate the incidence of the first occurring CVRD manifestation and cumulative hospitalization costs of each CVRD manifestation for type 2 diabetes without CVRD history. Methods A cohort study of all type 2 diabetes free of CVRD as of January 1st 2014, was identified and followed-up for 5 years within the French SNDS nationwide claims database. The cumulative incidence of the first occurring CVRD manifestation was estimated using the cumulative incidence function, with death as a competing risk. Cumulative hospitalization costs of each CVRD manifestations were estimated from the perspective of all payers. Results From 2,079,089 type 2 diabetes without cancer or transplantation, 76.5% were free of CVRD at baseline with a mean age of 65 years, 52% of women and 7% with microvascular complications history. The cumulative incidence of a first CVRD manifestation was 15.3% after 5 years of follow-up with a constant linear increase over time for all CVRD manifestations: The most frequent was CKD representing 40.6% of first occurred CVRD manifestation, followed by HF (23.0%), then PAD (13.5%), stroke (13.2%) and MI (9.7%). HF and CKD together reached about one patient out of ten after 5 years and represented 63.6% of first CVRD manifestations. The 5-year global cost of all CVRD hospitalizations was 3.9 billion euros (B€), i.e. 2,450€ per patient of the whole cohort, with an exponential increase over time for each specific CVRD manifestation. The costliest was CKD (2.0 B€), followed by HF (1.2 B€), then PAD (0.7 B€), stroke (0.6 B€) and MI (0.3 B€). Conclusions/interpretation While MI, stroke and PAD remain classic major risks of complications for CVRD-free type 2 diabetes, HF and CKD nowadays represent individually a higher risk and cost than each of these classic manifestations, and jointly represents a risk and a cost twice as high as these three classic manifestations all together. This should encourage the development of specific HF and CKD preventive strategies.

• Publisher: BioMed Central,Springer Nature B.V,BMC
• Subject: Aged / Angina pectoris / Angiology / Antidiabetics / Cardiology / Cardiovascular disease / Cerebral infarction / Chronic kidney disease / Codes / Cohort analysis / Cohort Studies / Comorbidity / Congestive heart failure / Diabetes / Diabetes mellitus (non-insulin dependent) / Diabetes Mellitus, Type 2 - diagnosis / Diabetes Mellitus, Type 2 - epidemiology / Diabetes Mellitus, Type 2 - therapy / Female / Health care expenditures / Health services utilization / Heart attacks / Heart Diseases / Heart failure / Heart Failure - diagnosis / Heart Failure - epidemiology / Heart Failure - therapy / Hospitalization / Hospitals / Humans / Hypertension, Renal / Incidence / Kidney diseases / Medicine / Medicine & Public Health / Microvasculature / Myocardial Infarction / Patients / Peripheral Arterial Disease / Registration / Reimbursement / Renal failure / Renal Insufficiency, Chronic - diagnosis / Renal Insufficiency, Chronic - epidemiology / Renal Insufficiency, Chronic - therapy / Sensitivity analysis / Stroke / Transplantation / Type 2 diabetes