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PubMed2006

Co-morbidity of select anxiety, affective, and psychotic disorders with cannabis dependence in Southwest California Indians.

Cannabis dependence is co-morbid with psychiatric disorders in general population surveys, but whether co-morbidity exists in American Indian populations is unknown. The aim of this study was to assess co-morbidity between cannabis dependence and psychiatric disorders in a community sample of Southwest California (SWC) Indians. Demographic information and DSMIII- R diagnoses, including differentiation of independent and cannabis-induced psychiatric disorders, were obtained using the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA) developed for the Collaborative Study on the Genetics of Alcoholism (COGA) from 513 SWC Indian adults residing on contiguous reservations. Although SWC Indians in this sample had high rates of cannabis dependence (43% in men and 24% in women), cannabis-induced psychiatric disorders each occurred in 1% or less of the sample. No significant co-morbidity with independent psychiatric disorders was found. In SWC Indians, cannabis dependence may be less etiologically related to psychiatric disorders than in the general population.

Adult↗
PubMed2004

Post-anesthesia recovery after infusion of propofol with remifentanil or alfentanil or fentanyl in morbidly obese patients.

BACKGROUND: The type of opioid used during general anesthesia in the morbidly obese influences recovery and the postoperative period. In a randomized clinical trial, the postoperative recovery profile and early period after general anesthesia with remifentanil, fentanyl and alfentanil were compared in morbidly obese patients. MATERIAL AND METHOD: 60 morbidly obese patients with BMI >35 kg/m(2) (mean 43.31) undergoing open Roux-en-y gastric bypass were randomly divided into 3 groups: remifentanil (R), fentanyl (F), and alfentanil (A). Dosage of opioids was based on ideal body weight (IBW): fentanyl 5 mcg/kg for intubation followed by infusion of 0.025-0.05 mcg/kg/min; alfentanil 15 mcg/kg initially, then 1.0-1.5 mcg kg/min; and remifentanil 1 mcg/kg followed by infusion of 0.25-1.5 mcg/kg/min. Anesthesia was induced with infusion of propofol and oxygen with N(2)O (1:1). After anesthesia, the duration to response to verbal command, spontaneous respiration, adequate respiration, and safe extubation were recorded. The incidence of postoperative nausea and vomiting were recorded. Using verbal scale for evaluation of postoperative pain, the early postoperative analgesia requirements were assessed. RESULTS: Demographic profiles and duration of procedure did not differ between groups. A total dose of propofol was significantly lower in Group R compared with Groups A and F (P <0.05). Duration to spontaneous respiration, adequate respiration and safe extubation were significantly shorter in Group R compared with Group F (P <0.05). Shortly after anesthesia, significantly more patients in Group R required additional dose of analgesic than in Group F (P <0.05). Postoperative nausea and vomiting (PONV) occurred significantly more often in Group R compared with Group F (P <0.05). Recovery profile of Group A was more similar to Group R, and postoperative pain and PONV evaluation more similar to Group F. CONCLUSION: In morbidly obese individuals, alfentanil or fentanyl and remifentanil can be safely used, but there is a higher rate of PONV and postoperative pain in the remifentanil group.

Adult↗
PubMed1991

Aorta and Iliac Arterial Sizes in Pre-operative Morbidly Obese Patients: a preliminary report.

Central blood flow and cardiac output are increased in most morbidly obese patients. This may be reflected in abnormal vessel sizes. Other influences such as smoking, age, weight, vertebral size, hypertension and age at onset of obesity may also be operative. Abnormal aorta and common iliac artery diameters were retrospectively measured on abnormal computer-assisted axial tomography scans of 44 morbidly obese, vascular disease-free females prior to their bariatric surgery. They were compared at standardized aortic and ileac levels with normal weight, similar age, control patients. There was no correlation between patient body weight, body mass index, percent excess body weight or age at onset of obesity versus any of the aortic or iliac diameters. Pearson's correlation analysis of smoking, age and hypertension each showed a significant positive relationship with aorto-iliac diameters (p < 0.05). Vertebral coronal body widths revealed a significant correlation with age (p < 0.05) but not with body weight, aortic or iliac diameters at any level. We conclude that the aortic and iliac arterial diameters of morbidly obese patients are significantly enlarged relative to normal weight controls. Smoking, age and hypertension also appear to have some degree of influence on aorto-iliac diameters in morbidly obese middle-aged women.

Journal Article↗
PubMed1992

Eutrophication: spontaneous progressive dermatoliponecrosis. A Fatal Complication of Gross Morbid Obesity.

Spontaneous and progressive dermatoliponecrosis and panniculitis is an unusual complication of morbid obesity. A fatal case is reported, and the term eutrophication is suggested as an appropriately descriptive name for this intractable condition. A 45-year-old grossly morbidly obese female (weighing 286.4 kg) presented with spontaneous necrosis of skin and fat-folds of the abdomen, trunk, and thighs. She also had congestive cardiac failure, respiratory insufficiency and anemia. Congestive cardiac failure and anemia were treated aggressively. However, all attempts at control of the superficial tissue necrosis and the supervening infection failed. Superficial gangrene and putrefaction of the fat-folds progressed relentlessly, and death finally ensued due to sepsis and multiple system failure. The early signs of panniculitis, especially of grossly dependent fat and skin-folds in the morbidly obese must be recognized early and treated with aggressive weight loss, if this potentially fatal complication of morbid obesity is to be avoided.

Journal Article↗
PubMed1992

Hepatic Abnormalities in Obesity: comparison between mildly obese cases and morbidly obese cases.

Hepatic morphology and clinical course of mildly obese subjects with abnormal liver tests were determined in comparison with those of surgically treated morbidly obese cases. Twenty mildly obese subjects (mean body mass index, 27.9) with elevated serum transaminase levels were followed up on a low-calorie diet. Nineteen morbidly obese patients (mean body mass index, 39.2) had a surgical biopsy at gastric restrictive surgery. In these two groups, the frequency and the severity of hepatic steatosis and fibrosis were comparable, whereas intralobular cell infiltration was somewhat greater in the mildly obese group. Follow-up studies of the two groups showed remarkable improvement of serum transaminase levels, the extent of which was greater in surgically treated cases. Thus, in mildly obese subjects with abnormal liver tests, (1) hepatic histological abnormalities are not milder than those in morbidly obese cases, and (2) Improvement of serum transaminase levels upon diet therapy is less satisfactory than that in morbidly obese cases treated surgically. It is suggested these two groups may not be in the same spectrum of obesity-related hepatic disorders.

Journal Article↗
PubMed1995

Results of Bariatric Surgery for Morbid Obesity in Patients Older than 50 Years.

BACKGROUND: Surgery is increasingly used for weight loss in morbidly obese patients. The authors evaluated the safety and efficacy of bariatric surgery in patients older than 50 years. METHODS: Prospective data on 62 consecutive patients (Male = 13, Female = 49) undergoing bariatric procedures between 1985-1994 were reviewed. Mean follow-up was 30 +/- 2 months (3-48 months). All data are mean +/- SEM. RESULTS: Age was 57 +/- 1 year (range 50-71 years). Patients had a mean preoperative weight of 125 + 4 kg (275 +/- 9 lb) and 119 +/- 6% excess body weight. A total of 68 procedures were performed: vertical banded gastroplasty (VBG = 23), Roux-en-Y gastric bypass (RYGB = 43), and billopancreatic diversion (BPD = 2). Six patients were converted to RYGB (5) and BPD (1) after failed VBG. Hospital mortality was nil. Complications were wound infection (5), pulmonary (4) gastric leak (2) abscess (1) and others (4). Mean weight loss at 3 year; was 55 +/- 7 and 33 +/- 6% of percent excess body weight for RYGB and VBG, respectively. Postoperative use of medications for arthritis, diabetes mellitus and asthma was reduced by 23%, 62% and 100%, respectively. Satisfaction with the outcome of treatment and weight loss was reported by 81 % of patients. Six patients that were converted from jejunoileal bypass (metabolic complications) to VBG gained weight. CONCLUSIONS: Bariatric surgery is safe and well tolerated in morbidly obese patients older than 50 years. Weight loss parallels that of younger populations and is greater in patients treated with RYGB in this subgroup. Age should not be a contraindication to bariatric surgery provided the patient has obesity-related medical morbidity. Control of obesity-related co-morbid conditions is improved by weight loss.

Journal Article↗
PubMed1995

The Effects of Fat Distribution on Resting Energy Expenditure in Premenopausal Morbidly Obese Females.

BACKGROUND: upper body, or abdominal, distribution of body fat is associated with a number of metabolic and hormonal aberrations that could influence resting energy expenditure REE. The purpose of our study was to examine the effects of fat distribution on REE of 96 morbidly obese premenopausal females. METHODS: the study population consisted of three groups of study subjects, 32 with lower body fat distribution (LBD) and waist-to-hip circumference ratios WHR < 0.80, 20 with intermediate (INT) fat distribution and WHR between 0.80 and 0.85 and 34 females with upper body distribution of fat (UBD) and WHR > 0.85. Indices measured included: (1) REE; (2) maximal oxygen consumption during an exercise tolerance test (VO&inf2; max); (3) basal respiratory quotient (RO); (4) fasting blood glucose; and (5) serum cholesterol and triglycerides. RESULTS: we found that morbidly obese women who store fat abdominally (WHR > 0.80) have significantly (p < 0.01) higher REE (kcal per h per BSA) than those with lower body obesity. Levels of triglyceride and glucose of the UBD group were also higher than those of the LBD subjects, i.e. 35% and 23%, respectively. VO&inf2; max and RO were similar between the study groups, suggesting that the elevated REE of the patients with abdominal adiposity were likely not the result of their greater muscle mass or differences in substrate utilization. CONCLUSION: fat distribution affects REE in morbidly obese premenopausal females, and further research is needed to identify the various entities regulating REE in the morbidly obese.

Journal Article↗
PubMed2006

A multimodality approach to the treatment of craniopharyngiomas avoiding hypothalamic morbidity: a UK perspective.

The management of craniopharyngiomas is complex and controversial. The perception that they are benign tumours cured by radical surgical resection is not borne out by their often difficult excision, propensity to recur and invade, and high late morbidity and mortality from direct brain injury. Their central location makes visual or pituitary dysfunction and/or hydrocephalus common presenting features. The most important consequence of craniopharyngiomas is hypothalamic injury which may result in severe, crippling and life-threatening sequelae, such as adipsia, morbid obesity, sleep, and behavioural and cognitive disorders. Evidence suggests that unless the tumour is smaller than 2-4 cm in the mid-line and completely resectable without additional hypothalamic or visual compromise, the surgical approach should be conservative even if this leaves residual tumour. Adjuvant focal radiotherapy to residual or recurrent disease has proven efficacy in long-term tumour control. Thus concerns regarding the potential late toxicity of radiotherapy to the developing brain need to be balanced against the recognised morbidity and mortality of recurrent tumour and repeated neurosurgical interventions. Hypothalamic damage is in many cases surgically induced. Given the devastating consequences of such an injury this should be avoided at all costs. Thus the aims of primary treatment should be to relieve tumour-associated compression symptoms, preserve (or improve) vision and hypothalamo-pituitary function, and minimise tumour recurrence with its attendant high morbidity and mortality. National registration and management by multidisciplinary teams in specialised centres according to nationally agreed risk adapted treatment strategies are likely to improve outcomes, as has been demonstrated for example in adult pituitary tumours. Because of the rarity of craniopharyngiomas, international collaborative trials are necessary to properly inform future therapies.

Combined Modality Therapy↗
PubMed2000

Pediatric tuberculosis: what needs to be done to decrease morbidity and mortality.

OBJECTIVE: Tuberculosis (TB) control programs have been less successful among children than among adults in the United States. Between 1992 and 1997, the rate of decline of TB cases among 0- to 14-year-old children was less than the rate of decline among any other age group of US-born persons. Because of the higher prevalence of active TB among adults and their higher infectivity, most programs for TB in the United States have targeted adults. The inherent assumption has been that by targeting adults, from whom children may become infected, TB morbidity and mortality among children also will be reduced effectively. METHODS: Using a semi-Markov model that divided the US population into age groups <15 years old and >/=15 years old and into 18 clinical states based on the risk for or presence of TB and human immunodeficiency virus infection, we developed a computer-based simulation model to examine the effect of a range of potential TB control strategies on projected TB cases and deaths in children. We compare the impact of interventions targeted at children with the impact of interventions targeted at adults on pediatric morbidity and mortality. RESULTS: After 10 years, a 5% increase in the number of adults with TB who enter treatment would only lead to a.05% decline in TB cases among children, compared with predicted cases without this intervention. Improving treatment efficacy among those adults who are already receiving treatment for their TB leads to a smaller decline in cases among children of only.003%. In contrast, a 5% increase in the number of children who enter treatment leads to a 25% decline, after 10 years, in the number of TB cases among children and a 16% decline in the number of TB deaths. In the presence of immigration of tuberculin-positive children, the benefit of targeting programs directly at children is magnified. CONCLUSIONS: Marginal changes in programs targeted directly at children are significantly more effective at further reducing pediatric TB morbidity and mortality than the same changes in programs targeted at adults with the indirect goal of reducing spread to children. Marginal increases in the number of children who enter treatment are far more effective at decreasing morbidity and mortality than equivalent marginal increases in treatment effectiveness. Unfortunately, declining insurance coverage and increasing restrictions on services to immigrants have made it harder for those who are at greatest risk of TB to get medical care. Marginal increases in preventive therapy rates substantially reduce future pediatric TB cases and deaths among children with TB infection and human immunodeficiency virus.

Adolescent↗
PubMed2006

Treated hypotension is associated with neonatal morbidity and hearing loss in extremely low birth weight infants.

BACKGROUND: Neonatal hypotension may be a risk factor for neurologic impairment. Few studies have examined the impact of low blood pressure in extremely low birth weight (ELBW) infants weighing 400 to 999 g on neurodevelopmental outcome. OBJECTIVES: We set out to explore the relationship between treated hypotension in the first 72 hours of life and perinatal factors, morbidity, and mortality in ELBW infants and then to compare neurosensory outcome in ELBW infants with treated hypotension and those who never received treatment for hypotension. DESIGN/METHODS: We performed chart review of all 156 ELBW infants admitted to our level III NICU in 1998-1999. Infants had "treated hypotension" if they received fluid pushes, corticosteroids, and/or vasopressors during the first 72 hours of life in an attempt to increase blood pressure. Follow-up included neurologic examination, Bayley Scales of Infant Development, vision and hearing evaluation. Statistical analysis was performed by using SPSS 11.0. Univariate and multivariate analyses were conducted to determine morbidities associated with treated hypotension. RESULTS: Fifty-nine infants received treatment for hypotension. Ninety-seven infants did not. The groups had similar race, gender, delivery mode, chorioamnionitis, and maternal socioeconomic status. Thirty-eight (24%) infants expired, including 20 who received treatment for hypotension. Of the 156 infants in the study group, 110 underwent neurodevelopment testing, and 103 were able to undergo complete neurodevelopment testing and Bayley examination. Multivariate analysis controlling for socioeconomic status and neonatal morbidity revealed that treated hypotension is associated with delayed motor development and hearing loss. CONCLUSIONS: Treated hypotension in ELBW infants in the first 72 hours of life is associated with significant short-term and long-term morbidity. Infants with treated hypotension are more likely to have delayed motor development, hearing loss, and death.

Blood Pressure↗
PubMed2005

Chance of psychiatric morbidity amongst recently diagnosed cancer outpatients attending a chemotherapy unit.

The prevalent rate of psychiatry morbidity amongst patients with cancer reported in various studies ranges from 5 to 50%, a variation that can be attributed to differences in sample size, the disease itself and treatment factors. The objectives of the present study were to determine the frequency of psychiatric morbidity amongst recently diagnosed cancer outpatients and try to identify which factors might be related to further psychological distress. Two hundred and eleven (70.9%) female patients and 87 (29.1%) male patients from the chemotherapy unit of the Cancer Hospital A.C. Camargo (São Paulo) completed a questionnaire that featured data on demographic, medical and treatment details. The Self Reporting Questionnaire (SRQ-20) was administered to the patients to determine their personal psychiatric morbidity. Seventy-two patients (25.8%) scored > or = 8 in the SRQ-20, the cut-off point for a patient to be considered a psychiatric case. When the low and high scoring groups were compared no differences were detected regarding age, marital status, tumor site, sex, or previous treatment. Nonetheless, patients in the lowest social class and those who were bedridden less than 50% of the time had a significantly higher probability of being a psychiatric case. Regarding help-seeking behavior in situations in which they had doubts or were frightened, about 64% of the total sample did not seek any type of support and did not talk to anyone. This frequency of psychiatric morbidity agrees with data from the cancer literature. According to many investigators, the early detection of a comorbid psychiatric disorder is crucial to relieve a patient's suffering.

Adolescent↗
PubMed2007

Gender differences in self-reported morbidity: evidence from a population-based study in southern Brazil.

This paper aims to assess variations in self-reported morbidity between men and women using six different measures of reported illness. The cross-sectional study was conducted in the municipality of Rio Grande, southern Brazil. Demographic, socioeconomic, and morbidity data were collected from a probabilistic sample of 1,260 persons aged 15 years or over, using a specific questionnaire. Statistical analysis included a multivariate Poisson regression analysis. Prevalence Ratios (PR) with 95% confidence intervals (95%CI) were calculated. After adjusting for some confounding variables (age, race, unemployment, marital status, income, social class, and education), women showed greater risk of any symptom (PR = 3.21; 95%CI: 2.71-3.83), three or more symptoms (PR = 4.22; 95%CI: 2.97-5.98), potentially serious symptoms (PR = 1.75; 95%CI: 1.31-2.34), poor/fair health (PR = 1.78; 95%CI: 1.37-2.32), and minor psychiatric disorders (PR = 1.76; 95%CI: 1.31-2.37). The study revealed dissimilarity in self-reported morbidity between men and women in southern Brazil, but with different degrees depending on type of morbidity. This excess can be explained by gender difference in health-seeking behavior for perceiving or reporting health problems.

Adolescent↗
PubMed1993

Morbidity of allergic rhinitis based on the National Health Insurance records of Japan.

The morbidity of allergic rhinitis (AR) based on Japan National Health Insurance records was calculated from 1981 to 1990. The data shows a three-fold increase of the rate for AR patients in those 10 years. Additionally, Aichi Prefecture's morbidity of AR was analysed for May 1991. When cross-sectional methods were used for May 1991, it was found that the morbidity of AR showed little correlation with the pollen count for Japanese cedars and Japanese cypresses. However, the results suggested possible correlations between the morbidity of AR and the mean yearly levels of the pollutant components SPM and NO2.

Air Pollutants, Occupational↗
PubMed1996

Hemodialysis vascular access morbidity.

Complications associated with hemodialysis vascular access represent one of the most important sources of morbidity among ESRD patients in the United States today. In this study, new data on the magnitude and growth of vascular access-related hospitalization in the United States is presented, demonstrating that the costs of this morbidity will soon exceed $1 billion per yr. This study also reviews published literature on the morbidity associated specifically with native arteriovenous fistulae, polytetrafluoroethylene bridge grafts, and permanent central venous catheters. Next, new information on the changing patterns of vascular access type in the United States is presented, demonstrating the continuing evolution of medical practice away from the use of arteriovenous fistulae in favor of more reliance on synthetic bridge grafts. Based on these data, a discussion is provided of the tradeoffs among the most commonly available modalities of vascular access today. Although radial arteriovenous fistulae continue to represent the optimal access modality, the appropriate roles for brachial arteriovenous fistulae, synthetic bridge grafts, and central venous catheters are less certain because of inadequate data on the long-term function of the first and the high rates of complications associated with the latter two. To reduce vascular access-related morbidity, strategies must be developed not only to prevent and detect appropriately early synthetic vascular access dysfunction, but to better identify the patients in a whom radial arteriovenous fistula is a viable clinical option.

Age Factors↗
PubMed1996

The elimination of selected chronic diseases in a population: the compression and expansion of morbidity.

OBJECTIVES: This study evaluates the effect of eliminating a specific disease on the mortality, long-term disability, and overall health status of a population. Primarily, it examines whether elimination leads to a compression of morbidity. METHODS: The Sullivan method was used to calculate disability-free life expectancy. Cause-deleted disability prevalence was estimated with a multiple logistic regression model that used data from the Dutch National Survey of General Practice. Cause-deleted probabilities of dying were derived with the cause-elimination life-table technique, assuming independence among competing causes of death. RESULTS: Eliminating disabling nonfatal diseases such as arthritis/back complaints results in a decline in life expectancy with disability--that is, an absolute compression of morbidity. Eliminating highly fatal diseases such as cancer leads to an increase in the number of years and the proportion of life with disability--that is, a relative expansion of morbidity. CONCLUSIONS: While eliminating fatal diseases leads to an increase in disability-free life expectancy, life expectancy with disability may increase as well. This represents an increasing burden to society. On the other hand, eliminating nonfatal disabling diseases leads to absolute compression of morbidity.

Adolescent↗
PubMed2006

Association of co-morbidities with prescribing patterns and cost savings: olanzapine versus risperidone for schizophrenia.

BACKGROUND: Olanzapine and risperidone are two commonly prescribed atypical antipsychotics for schizophrenia. Prior studies have shown inconsistent results in terms of advantage in cost saving in prescribing these agents. Our preliminary analysis showed that a small percentage of intensive healthcare utilizers had substantial impact on healthcare costs. This study analysed the cost effects of olanzapine and risperidone among those who had intensive utilisation of medical care prior to drug initiation, and the relationship between the choice of the two drugs and patients' co-morbid condition. METHODS: We retrospectively investigated patients first treated with either risperidone or olanzapine between 1 April 1999 and 31 March 2000. According to patients' medication history during the 6 months prior to initial prescription of a study medication we categorised patients into three groups: (i) not receiving olanzapine or risperidone; (ii) not receiving any atypical antipsychotic agent; or (iii) not receiving any antipsychotic agent. We then compared the difference in cost saving by type of care in the 10% most expensive patients through bivariate and multivariate analyses. Based on the records of 18 499 patients with schizophrenia prescribed either olanzapine or risperidone between 1 April 1999 and 31 March 2000 we defined intensive users of healthcare as those who incurred an annual total cost in the top tenth percentile. We measured co-morbidity by number of diseases, and healthcare costs ($US, 1998-2001 values) in the year prior and the year after treatment initiation in six categories of care (inpatient medical/surgical, inpatient psychiatric care, other inpatient, outpatient psychiatric care, other outpatient and outpatient pharmacy). RESULTS: The top 10% most expensive patients accounted for about half of the total cost of the entire cohort and had nearly a 40% cost reduction for the year after treatment initiation versus the prior year, while the entire cohort increased cost between 2% and 12%. Compared with those prescribed olanzapine, patients prescribed risperidone had more medical co-morbidities, higher inpatient medical/surgical costs and lower psychiatric costs. Patients taking olanzapine had greater cost reduction in inpatient psychiatric care, whereas those taking risperidone had greater reduction in inpatient medical/surgical care. CONCLUSIONS: Among the top 10% most expensive patients, olanzapine and risperidone treatments were associated with comparable cost reductions in inpatient care. The choice of agent was associated with patients' co-morbid condition and was correlated with cost reduction in inpatient medical/surgical or psychiatric care.

Antipsychotic Agents↗
PubMedDate not supplied

Neonatal morbidity among infants of diabetic mothers.

While the modern approach to management of diabetic pregnancy has reduced the perinatal mortality significantly, the neonatal morbidity remains high. This study has investigated factors which may account for the persisting high neonatal morbidity when birth trauma has been virtually eliminated and the incidence of respiratory distress syndrome (RDS) considerably reduced. Major congenital malformations emerge not only as the leading cause of perinatal losses but also as an important cause of morbidity. Delivery before 37 weeks increased the incidence of RDS and hypocalcemia, and it is suggested that, when strict metabolic control is used and with the help of facilities to monitor the fetus closely in the last weeks of pregnancy, the number of infants delivered at this early date can be further reduced. The present study also indicates that normoglycemia should also be encouraged on the day of delivery as maternal hyperglycemia at this stage increases the incidence of neonatal hypoglycemia. Jaundice, which very commonly affects newborn infants of diabetic mothers, is influenced by the use of oxytocin for vaginal delivery and by infant overweight (greater than 90th percentile) at birth, factors which are not beyond control. Finally, route of delivery per se may not be important in relation to neonatal morbidity.

Blood Glucose↗
PubMed1994

Comparison of excess costs of care and production losses because of morbidity in diabetic patients.

OBJECTIVE: To assess and compare excess costs of care and production losses because of morbidity in diabetic patients and the general population of a Swedish community. RESEARCH DESIGN AND METHODS: Costs of production losses were calculated from medical and social insurance records on sickness benefit days (short-term illness) and premature retirement (permanent disability) in people with diabetes and in the entire population of the community (a municipality comprising a town and rural surroundings, with 28,000 inhabitants). Care costs included those of consultations and inpatient care, as well as costs of insulin, oral antidiabetic medications, other drugs, test material, and treatment devices, and they were obtained from patient records, the health care administration, and the statistics of community pharmacy sales. RESULTS: Of the diabetic patients < 65 years of age, above which both diabetic and nondiabetic people get retirement pension, and sickness benefits cease, 62% of those on insulin treatment in each gender had insulin-dependent diabetes mellitus (IDDM). All insulin-treated non-insulin-dependent diabetes mellitus (NIDDM) patients were > 40 years of age. Both the insulin-treated and the non-insulin-treated diabetic patients were prematurely retired twice as often as the average population and had twice as many inpatient days. The insulin-treated subjects also had twice as many sickness benefit days. The excess costs of production losses as a result of morbidity in people with diabetes were about $7,000 per individual and year. The corresponding excess costs of inpatient care were $800. The therapeutic expenditures for control of diabetes were about $600 per individual and year. If converted to U.S. conditions, the costs of lost production as a result of excess morbidity (< 65 years of age) would be $12 billion and $9 billion for people with insulin-treated and non-insulin-treated diabetes, respectively. CONCLUSIONS: If improved metabolic control by intensified treatment would reduce excess morbidity in both IDDM and NIDDM, the predominant costs of production losses imply that intensified antidiabetic treatment might save costs.

Adult↗