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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

Research Square
2023
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Metric Options:   Counts1 Year3 Year

Article Description

Background Myocardial infarction (MI), stroke, peripheral arterial disease (PAD), heart failure (HF) and chronic kidney disease (CKD) are common cardiovascular renal disease (CVRD) manifestations for type 2 diabetes. The incidence of the first occurring CVRD manifestation and cumulative hospitalization costs of each CVRD manifestation are not well known 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 about 2 million 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 of these three classic manifestations all together. This should encourage the development of specific HF and CKD preventive strategies.

Bibliographic Details

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

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Biochemistry, Genetics and Molecular Biology; Immunology and Microbiology; Medicine; Neuroscience; Psychology; Dentistry

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