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Effects of Body Mass Index and Pay-for-Performance Program on Risk of Death in Patients with Type 2 Diabetes: A Nationwide Cohort Study

Author

Listed:
  • Hsiu-Ling Huang

    (Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu County 304, Taiwan)

  • Chuan-Yu Kung

    (Department of Nursing, Hengchun Tourism Hospital, Ministry of Health and Welfare, Pingtung County 94641, Taiwan)

  • Shun-Mu Wang

    (Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu County 304, Taiwan)

  • Pei-Tseng Kung

    (Department of Healthcare Administration, Asia University, Taichung City 41354, Taiwan
    Department of Medical Research, China Medical University Hospital, China Medical University, Taichung City 40402, Taiwan
    These authors contributed equally to this work.)

  • Yen-Hsiung Lin

    (Department of Pediatrics, Hengchun Tourism Hospital, Ministry of Health and Welfare, Pingtung County 94641, Taiwan)

  • Li-Ting Chiu

    (Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan)

  • Wen-Chen Tsai

    (Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan
    These authors contributed equally to this work.)

Abstract

Background: The diabetes patients enrolled in the pay-for-performance (P4P) program demonstrate reduced risk of death. Body mass index (BMI) is a risk factor of all-cause death. This study investigates the effects of BMI and P4P on the risk of death in type 2 diabetes patients. Methods: This is a retrospective cohort study. The study population includes the 3-wave National Health Interview Survey in Taiwan. A total of 6354 patients with diabetes aged ≥ 20 years were enrolled and followed up until the end of 2014. Results: The highest mortality rate per 1000 person-years was 61.05 in the underweight patients with diabetes. A lower crude death rate was observed in the P4P participants than non-P4P participants. The risk of death was 1.86 times higher in the underweight patients with diabetes than that in the normal weight group (95% CI: 1.37–2.53) and was lower in the P4P participants, as compared to the non-participants (HR: 0.55, 95% CI: 0.44–0.69). The most significant effect of joining the P4P program in reducing death risk was found in the underweight patients with diabetes (HR: 0.11, 95% CI: 0.04–0.38), followed by the obesity group (HR: 0.30, 95% CI: 0.17–0.52). Conclusions: Different effects of joining the P4P program on reducing death risk were observed in the underweight and obesity groups. We strongly recommend that patients with diabetes and without healthy BMIs participate in the P4P program.

Suggested Citation

  • Hsiu-Ling Huang & Chuan-Yu Kung & Shun-Mu Wang & Pei-Tseng Kung & Yen-Hsiung Lin & Li-Ting Chiu & Wen-Chen Tsai, 2021. "Effects of Body Mass Index and Pay-for-Performance Program on Risk of Death in Patients with Type 2 Diabetes: A Nationwide Cohort Study," IJERPH, MDPI, vol. 18(9), pages 1-16, April.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:9:p:4648-:d:544671
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    References listed on IDEAS

    as
    1. Yeongkeun Kwon & Hyun Jung Kim & Sungsoo Park & Yong-Gyu Park & Kyung-Hwan Cho, 2017. "Body Mass Index-Related Mortality in Patients with Type 2 Diabetes and Heterogeneity in Obesity Paradox Studies: A Dose-Response Meta-Analysis," PLOS ONE, Public Library of Science, vol. 12(1), pages 1-14, January.
    2. Neeru Gupta & Holly M. Ayles, 2019. "Effects of pay-for-performance for primary care physicians on diabetes outcomes in single-payer health systems: a systematic review," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(9), pages 1303-1315, December.
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    Cited by:

    1. Liao, Yi-Shu & Tsai, Wen-Chen & Chiu, Li-Ting & Kung, Pei-Tseng, 2023. "Educational attainment affects the diagnostic time in type 2 diabetes mellitus and the mortality risk of those enrolled in the diabetes pay-for-performance program," Health Policy, Elsevier, vol. 138(C).

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