Relation Between Outpatient Medical Expenses and Self-Rated Health in Patients With Hypertension, Dyslipidemia, and Diabetes Mellitus Covered by National Health Insurance

Abstract

Background: This study was performed to clarify the relations between subjective self-rated health and outpatient medical expenses as an objective measure in patients with hypertension, dyslipidemia, and/or diabetes mellitus. Methods: We analyzed self-rated health of individuals aged 40–74 years in Unzen and Shimabara cities based on responses to the anonymous self-administered Nagasaki Prefectural Citizen’s Health Survey in 2021 along with data from the national health insurance database for both cities from fiscal year 2020. Results: Data for 1395 respondents to the Nagasaki Prefectural Citizen’s Health Survey covered by national health insurance who incurred outpatient medical expenses in relation to hypertension, dyslipidemia, and/or diabetes mellitus were included in the study. In univariate analysis, outpatient medical expenses were significantly associated with self-rated health in the groups with one or two of the above diseases (χ test, both P < 0.01). Logistic regression analysis adjusted for measures of socioeconomic status, including age, sex, cohabitation/family structure, number of years of education, employment status, and subjective economic status, showed that poor self-rated health was significantly associated with high annual outpatient medical expenses of JPY 100,000 (~US $650). or more in groups with one or two of the above diseases (adjusted odds ratio [AOR], 2.41, 95% confidence interval [CI], 1.60–3.61, AOR, 2.20, 95% CI, 1.41–3.43, respectively). In the one-disease cohort, having diabetes mellitus alone was significantly associated with higher outpatient medical expenses (AOR, 2.63, 95% CI, 1.50–4.63). In contrast, none of the conditions showed a significant association with higher outpatient medical expenses in the two-disease cohort. Conclusions: Poor self-rated health was significantly associated with high outpatient medical expenses in the population covered by national health insurance with one or two of hypertension, dyslipidemia, and/or diabetes mellitus. These associations may have been influenced by the prevalence of diabetes mellitus in the population.