Supplementary Material for: Noncommunicable Diseases and Hospital Utilization in Kuwait: A Generalizable Approach Using the World Health Survey

Background: Kuwait and countries in the Arabian Gulf region face an alarming prevalence of noncommunicable diseases (NCDs) that strain their health systems and threaten their economies. To quantify a key dimension of the burden, we estimated the risk of hospital utilization associated with diagnoses of the most prevalent NCDs, excluding cancer, in Kuwait using a generalizable approach amicable to cross-country disease burden comparisons and assessments of primary care effectiveness. Methods: The study analyzed responses from a nationally representative sample of 2,165 individuals with self-reported hospital admissions in the last 12 months and NCD diagnoses from the World Health Survey in Kuwait in 2010. Hospital utilization rates were examined for individuals diagnosed with hypertension, diabetes mellitus, asthma, chronic lung condition, heart disease, and stroke rates and adjusted for demographic and socioeconomic factors. Count regressions were used to estimate the association between individual NCDs and adjust for other covariates. Results: Using negative binomial regressions, we found that hypertension, the most common NCD in Kuwait, was associated with 75% higher hospital utilization. In addition, heart disease was associated with a 495% increase in hospital utilization rates after adjusting for potential confounders. Many other demographic, socioeconomic, and behavioral characteristics confounded the sizable increase in the risk of hospital admissions associated with NCDs. Conclusions: We estimated the substantial burden on curative services associated with NCDs in Kuwait through a standardized approach to compare hospital utilization rates associated with various NCDs that is generalizable to more than 70 countries that participated in the World Health Survey.

背景：科威特及阿拉伯海湾地区各国正面临着令人警惕的非传染性疾病（noncommunicable diseases, NCDs）高流行态势，此类疾病不仅对当地医疗系统造成沉重负担，更对其经济发展构成严重威胁。为量化该疾病负担的关键维度，本研究采用适用于跨国疾病负担比较与初级医疗服务效果评估的可推广研究方法，针对科威特境内除癌症外的最常见非传染性疾病诊断情况，估算与之相关的住院服务利用风险。
方法：本研究分析了2010年科威特世界卫生调查（World Health Survey）的数据，该数据来自具有全国代表性的样本，共纳入2165名自我报告在过去12个月内存在住院经历且被诊断为非传染性疾病的受访者。研究针对被诊断为高血压、糖尿病（diabetes mellitus）、哮喘、慢性肺部疾病、心脏病及中风的个体，分析其住院服务利用率，并针对人口统计学与社会经济因素进行了校正。本研究采用计数回归模型，估算各类单一非传染性疾病与住院服务利用之间的关联，并对其他协变量进行了校正。
结果：通过负二项回归（negative binomial regressions）分析，本研究发现，作为科威特最常见非传染性疾病的高血压，与住院服务利用率升高75%相关。此外，在校正潜在混杂因素后，心脏病与住院服务利用率升高495%相关。诸多其他人口统计学、社会经济及行为特征，均会对非传染性疾病相关的住院就诊风险升高产生混杂作用。
结论：本研究通过标准化方法估算了科威特境内非传染性疾病给诊疗服务带来的沉重负担，该方法可对比各类非传染性疾病相关的住院服务利用率，且可推广至参与世界卫生调查的70余个国家。