Burden of established cardiovascular disease in people with type 2 diabetes and matched controls: Hospital-based care, days absent from work, costs and mortality

Persson S, Nilsson K, Karlsdotter K, Skogsberg J, Gustavsson S, Jendle J, Steen Carlsson K

This is one of IHE’s two studies focusing on people with type 2 diabetes and established cardiovascular disease (eCVD) in Sweden that have been published in the medical journal “Diabetes, Obesity and Metabolism”. This study examines the burden of hospital-based care, work absence, associated costs and excess mortality in people with type 2 diabetes, with and without eCVD. The second study builds on the results and conducts a model-based analysis.

In a population-based cohort study, we analysed individual-level data from national health, social insurance and socio-economic registers for people diagnosed with type 2 diabetes before age 70 years and controls (5:1) in Sweden. Regression analysis was used to attribute costs and days absent due to eCVD. Mortality was analysed using Cox proportional hazard regression, stratified by birth year and adjusted for sex and education.

The results showed that the risk of death was four times higher for people with type 2 diabetes and eCVD compared to people in the control group without eCVD. Furthermore, 90 percent of the cost of hospital-based care of diabetes complications could be attributed to people with eCVD. Established cardiovascular disease was a leading cause behind the number of sick days, and the cost of sick leave due to cardiovascular disease in people with type 2 diabetes was found to be even higher than the costs of hospital-based care.

The main drivers of hospital-based care costs for people with type 2 diabetes and eCVD were acute myocardial infarction, angina pectoris and stroke; but also end-stage renal disease and eye disease, confirming that eCVD is associated with a range of other complications.

The study is a collaboration and has been carried out by the Institute for Health and Healthcare Economics, IHE, Örebro University and Boehringer Ingelheim AB. The studies were financed by Boehringer Ingelheim AB.

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Diabetes, Obesity and Metabolism 2023;25(3)726-734
DOI: https://doi.org/10.1111/dom.14919