Impact of malnutrition on survival and healthcare utilization in Medicare beneficiaries with diabetes: a retrospective cohort analysis

Abstract

ObjectiveThe aim of this study was to examine the impact of pre-existing malnutrition on survival and economic implications in elderly patients with diabetes.Research design and methodsA retrospective observational study was conducted to examine the impact of malnutrition with or without other significant health conditions on survival time and healthcare costs using the Centers for Medicare and Medicaid Services (CMS) data from 1999 to 2014 for beneficiaries with a confirmed first date of initial diagnosis of diabetes (n=15 121 131). The primary outcome was survival time, which was analyzed using all available data and after propensity score matching. Healthcare utilization cost was a secondary outcome.ResultsA total of 801 272 beneficiaries were diagnosed with malnutrition. The analysis on propensity score-matched data for the effect of common conditions on survival showed that the risk for death in beneficiaries with diabetes increased by 69% in malnourished versus normo-nourished (HR, 1.69; 99.9% CI 1.64 to 1.75; P<0.0001) beneficiaries. Malnutrition increased the risk for death within each of the common comorbid conditions including ischemic heart disease (1.63; 1.58 to 1.68), chronic obstructive pulmonary disorder (1.60; 1.55 to 1.65), stroke or transient ischemic attack (1.57; 1.53 to 1.62), heart failure (1.54; 1.50 to 1.59), chronic kidney disease (1.50; 1.46 to 1.55), and acute myocardial infarction (1.47; 1.43 to 1.52). In addition, the annual total spending for the malnourished beneficiaries was significantly greater than that for the normo-nourished beneficiaries ($36 079 vs 20 787; P<0.0001).ConclusionsMalnutrition is a significant comorbidity affecting survival and healthcare costs in CMS beneficiaries with diabetes. Evidence-based clinical decision pathways need to be developed and implemented for appropriate screening, assessment, diagnosis and treatment of malnourished patients, and to prevent malnutrition in normo-nourished patients with diabetes.

Hypoalbuminemia and Obesity in Orthopaedic Trauma Patients: Body Mass Index a Significant Predictor of Surgical Site Complications

“…Malnutrition as a risk factor for poor outcomes has been well established in the medicine literature [1][2][3][4][5][6] as well as the general surgery literature [7][8][9] . Within the field of orthopaedic surgery, hypoalbuminemia and obesity have been reported as significant risk factor for adverse outcomes in elective procedures, such as arthroplasty and spinal fusions [10][11][12][13][14][15] ,.…”

Factors related to malnutrition in community‐dwelling patients with schizophrenia

“…Physical health problems such as nutritional status are likely to be overlooked in schizophrenia; nurses have reportedly overlooked 30% of the risk of malnutrition in mental health clients . The nutritional status of individuals with chronic diseases, including mental illness, has been known to affect their survival rate, mortality, and quality of life . Therefore, nurses should be concerned about malnutrition among mental illness patients.…”

“…12 The nutritional status of individuals with chronic diseases, including mental illness, has been known to affect their survival rate, mortality, and quality of life. 10,[14][15][16][17][18] Therefore, nurses should be concerned about malnutrition among mental illness patients. Although there is a need for the assessment of the nutritional status of patients with schizophrenia and many factors contribute to malnutrition, studies on community-dwelling patients with schizophrenia are rare.…”

Association between Low Protein Intake and Mortality in Patients with Type 2 Diabetes

“…Although we could not perform detailed analyses on the relation between protein intake and cause-specific mortality because of a small sample size, the decrease in protein intake in older people will likely increase susceptibility to infection, due to decreased immunity and death from infection. In fact, malnutrition is known to be a significant risk factor for death in older patients with diabetes [26,27]. Therefore, lower consumption of proteins may have accelerated the mortality risk for frail patients with diabetes aged ≥ 75 years.…”