Academic Journal
Differential healthcare costs in individuals with type 2 diabetes and incident chronic kidney disease in Hong Kong: a latent class trajectory analysis.
| Τίτλος: | Differential healthcare costs in individuals with type 2 diabetes and incident chronic kidney disease in Hong Kong: a latent class trajectory analysis. |
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| Συγγραφείς: | Du Y; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China., Zhang M; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China., Li AQY; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China., Lau ESH; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China., Wu H; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China., Kong APS; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China., Luk AOY; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China., Ma RCW; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China., O CK; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China., Lim LL; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.; Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia., Zhang JYZ; National Center for Mental Health, Beijing, China., Ming WK; Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China.; Institute of Global Governance and Innovation for a Shared Future, City University of Hong Kong, Hong Kong SAR, China., Ke W; The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China., Li Y; The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China., Chan JCN; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China. jchan@cuhk.edu.hk.; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China. jchan@cuhk.edu.hk.; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China. jchan@cuhk.edu.hk., Lui JNM; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China. julianalui@cuhk.edu.hk.; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China. julianalui@cuhk.edu.hk.; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China. julianalui@cuhk.edu.hk. |
| Πηγή: | Diabetologia [Diabetologia] 2026 Jul; Vol. 69 (7), pp. 1792-1805. Date of Electronic Publication: 2026 Mar 18. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Springer Verlag Country of Publication: Germany NLM ID: 0006777 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-0428 (Electronic) Linking ISSN: 0012186X NLM ISO Abbreviation: Diabetologia Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Berlin Springer Verlag |
| Ιατρικοί όροι (MeSH): | Diabetes Mellitus, Type 2*/economics , Diabetes Mellitus, Type 2*/epidemiology , Diabetes Mellitus, Type 2*/complications , Renal Insufficiency, Chronic*/economics , Renal Insufficiency, Chronic*/epidemiology , Health Care Costs*/statistics & numerical data, Hong Kong/epidemiology ; Humans ; Female ; Male ; Middle Aged ; Latent Class Analysis ; Adult ; Aged ; Incidence ; Prospective Studies ; Comorbidity |
| Περίληψη: | Aims/hypothesis: Chronic kidney disease (CKD) represents a major and costly comorbidity in type 2 diabetes management. Identifying individuals with high healthcare costs due to CKD will support decision-making for early intervention. We used latent class analysis (LCA) to classify Chinese individuals with type 2 diabetes and incident CKD based on their demographic and clinical profiles. Methods: For this study, 2886 individuals with type 2 diabetes and incident CKD and complete data for 42 attributes were selected from the prospective Hong Kong Diabetes Register cohort (2007-2019). We used LCA to select 14 variables to classify participants, followed by a hierarchical generalised linear mixed model to evaluate longitudinal healthcare costs among class memberships. Results: During 109,784 person-years of follow-up, the incidence of CKD was 26.29 per 1000 person-years with a per-patient-per-year (PPPY) cost of US$4395 ± 11,947 (mean ± standard deviation). The four distinct classes used in the LCA based on baseline profiles were as follows: Class 1 (18.3%; PPPY: US$6087 ± 15,519), namely those who were young at onset (44.4 ± 10.3 years), had moderate comorbidities (25.6% had a moderate or high score on the Elixhauser Comorbidity Index [ECI]) and used multiple medications (90.2% used at least three medications); Class 2 (21.2%; PPPY: US$3822 ± 9816), namely those who had old-age onset (66.9 ± 6.9 years), had moderate comorbidities (27.8% had a moderate or high ECI score) and used multiple medications (70.7% used at least three medications); Class 3 (33.9%; PPPY: US$4260 ± 11,725), namely those who were middle-aged at onset (54.2 ± 10.0 years), had few comorbidities (14.0% had a moderate or high ECI score) and used few medications (15.6% used at least three medications); and Class 4 (26.5%; PPPY: US$3923 ± 10,957), namely those who were middle-aged at onset (54.1 ± 7.6 years), had moderate comorbidities (25.3% had a moderate or high ECI score) and used multiple medications (98.9% used at least three medications). Class 1 (young onset) and Class 3 (middle-aged onset) incurred the highest cost during the year of CKD onset, with those in Class 1 having more comorbidities than those in Class 3 at baseline. Multiple healthcare services contributed to the high healthcare costs in Class 1, with costs in Class 3 attributed mainly to post-CKD outpatient and psychiatric care. Conclusions/interpretation: Those with young-onset type 2 diabetes incurred the highest cost during the year of CKD onset. Individuals with middle-aged onset type 2 diabetes with fewer comorbidities and less intensified treatment at baseline also had subsequent increased healthcare costs. (© 2026. The Author(s).) |
| Competing Interests: | Acknowledgements: We express our gratitude to all participants of the HKDR, collaborating doctors, nurses and healthcare assistants for their contribution in establishing this 12-year cohort. An abstract from this study was presented at the International Diabetes Federation World Diabetes Congress of 2025 in Bangkok, Thailand, on 7–10 April 2025. Data availability: The participant-level data used and/or analysed during the current study are not available, since consent was not been obtained for data sharing. Summary data may be available from the corresponding author on reasonable request. Funding: A general research fund (reference no. 14121723) supported by the Research Grant Committee was awarded to JNML. The study sponsor/funder was not involved in the design of the study, in the collection, analysis and interpretation of data or in writing the report, and did not impose any restrictions regarding the publication of the report. Authors’ relationships and activities: APSK has received research grants and/or speaker honoraria from Abbott, Astra Zeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Kyowa Kirin, Merck Serono, Nestle, Novo Nordisk, Pfizer and Sanofi. AOYL reported receiving grants and/or honoraria for consultancy or giving lectures from Amgen, AstraZeneca, Boehringer Ingelheim, Merck Sharp & Dohme, Novartis, Novo Nordisk and Sanofi. RCWM reported receiving grants and/or honoraria for consultancy or giving lectures from AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Pfizer and Takeda and is a member of the editorial board of Diabetologia. L-LL reported receiving grants and/or honoraria for consultancy or giving lectures from AstraZeneca, Abbott, Boehringer Ingelheim, GSK, Novartis, Novo Nordisk, Viatris and Zuellig Pharma. JCNC has received research grants through her affiliated institutions and/or honoraria for consultancy or giving lectures from Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Celltrion, Eli Lilly, Hua Medicine, Merck, Merck Sharp & Dohme, Novo Nordisk, Novartis, Pfizer, Servier, Sanofi and Viatris. JNML has received a research grant from Roche Diagnostics Hong Kong Limited for a project unrelated to this manuscript. All other authors declare that there are no relationships or activities that might bias, or be perceived to bias, their contribution to this manuscript. Contribution statement: YD, MZ, AQYL, JCNC and JNML contributed to the concept and design. YD, MZ, JCNC and JNML conducted the analysis and drafted the manuscript. ESHL is the data manager of the HKDR and contributed to data curation and data cleaning. All authors contributed to data collection, interpretation of results and revision of the manuscript and approved the final version for submission. JCNC and JNML are the guarantors. Ethics approval and consent to participate: The study adhered to the Declaration of Helsinki, and written informed consent was obtained from all participants. The study was approved by the Clinical Research Ethics Committees of The Chinese University of Hong Kong (reference no. 2009.421). |
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| Grant Information: | 14121723 Research Grants Council, University Grants Committee |
| Contributed Indexing: | Keywords: Chronic kidney disease; EQ-5D-3L; Elixhauser Comorbidity Index; Healthcare costs; Latent class trajectory; Type 2 diabetes; Young-onset diabetes |
| Entry Date(s): | Date Created: 20260318 Date Completed: 20260608 Latest Revision: 20260813 |
| Update Code: | 20260813 |
| PubMed Central ID: | PMC13236821 |
| DOI: | 10.1007/s00125-026-06698-2 |
| PMID: | 41848900 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1432-0428 |
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| DOI: | 10.1007/s00125-026-06698-2 |