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诸国正面临非传染性疾病（noncommunicable diseases, NCDs）患病率高企的严峻局面，该类疾病不仅给当地医疗体系带来沉重负荷，更对区域经济构成威胁。为量化疾病负担的关键维度，本研究针对科威特人群中除癌症外的最常见非传染性疾病诊断情况，采用适配于跨国疾病负担比较与基层医疗服务效果评估的通用研究方法，估算与疾病诊断相关的住院服务利用风险。 方法：本研究分析了2010年科威特全国代表性样本的调研数据，该样本包含2165名自我报告近12个月内曾住院且经诊断患有非传染性疾病的受访者，数据来源于世界卫生调查（World Health Survey）。研究针对确诊高血压（hypertension）、糖尿病（diabetes mellitus）、哮喘（asthma）、慢性肺部疾病（chronic lung condition）、心脏病（heart disease）及脑卒中（stroke）的人群，分析其住院服务利用率，并针对人口学与社会经济特征进行校正。本研究采用计数回归（count regressions）模型，估算单种非传染性疾病与住院服务利用的关联，并校正其他协变量。 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，与住院服务利用水平升高75%相关。在校正潜在混杂因素（confounders）后，心脏病可导致住院服务利用率升高495%。其余多项人口学、社会经济及行为特征，均可对非传染性疾病相关的住院就诊风险增幅产生混杂偏倚。 结论：本研究通过可推广至参与世界卫生调查的70余个国家的标准化方法，估算了科威特地区非传染性疾病对诊疗服务造成的沉重负担；该方法可用于比较各类非传染性疾病对应的住院服务利用率。