The Comparison of Health Behaviors, Use of Health Services, and Health Expenditures among Diabetic Patients according to the Practice of Exercise

Ji Eun Cha; Soon Nyung Yun

doi:10.12799/jkachn.2015.26.1.31

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Cha and Yun: The Comparison of Health Behaviors, Use of Health Services, and Health Expenditures among Diabetic Patients according to the Practice of Exercise

Original Article

Journal of Korean Academy of Community Health Nursing 2015; 26(1): 31-41.

Published online: 31 March 2015

DOI: https://doi.org/10.12799/jkachn.2015.26.1.31

The Comparison of Health Behaviors, Use of Health Services, and Health Expenditures among Diabetic Patients according to the Practice of Exercise

Ji Eun Cha, Soon Nyung Yun

College of Nursing, Seoul National University, Seoul, Korea.

Corresponding author: Cha, Ji Eun. College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Korea. Tel: +82-10-9162-5121, jieun817@snu.ac.kr

Received 8 January 2015 Revised 11 March 2015 Accepted 20 March 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to compare the use of health services and health expenditures between non-exercise and exercise groups of diabetic patients and among three groups divided according to exercise intensity.

Methods

Data were obtained from the Korean Health Panel Survey of 2011. The participants of this study were 864 diabetic patients who did exercise (walk, moderate exercise, or vigorous exercise) or not. Data were subsequently analyzed using the SPSS 21 Program.

Results

The exercise group showed higher percentages of medication compliance, non-smokers, and regular diet than the non-exercise group. The hospitalization percentage, the number of outpatient hospital visits, and health expenditures were higher in the non-exercise group than in the exercise group. There was no difference among the three groups divided according to exercise intensity in the use of health services and health expenditures.

Conclusion

These results show that exercise is a way to reduce diabetic patients' use of health services and their health expenditures.

Keywords: Health expenditures, Health service, Health behavior, Diabetes mellitus, Exercise

Figures and Tables

Table 1

General Characteristics of the Participants

Variables	Categories	Total (n=864)	Exercise practice			Exercise intensity
			χ² (p)	Non-exercise (n=190)	Exercise (n=674)	Walk^a (n=365)	Moderate exercise^b (n=145)	Vigorous exercise^c (n=164)	χ² or F (p)
			χ² (p)	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	χ² or F (p)
Gender	Male	423 (49.0)	0.68 (.409)	88 (46.3)	335 (49.7)	138 (37.8)	83 (57.2)	114 (69.5)	49.69 (<.001)
Gender	Female	441 (51.0)	0.68 (.409)	102 (53.7)	339 (50.3)	227 (62.2)	62 (42.8)	50 (30.5)	49.69 (<.001)
Age (year)	20~39	15 (1.7)	20.84 (<.001)	1 (0.5)	14 (2.1)	7 (1.9)	1 (0.7)	6 (3.7)	31.56 (<.001)
	40~59	242 (28.0)		37 (19.5)	205 (30.4)	85 (23.3)	47 (32.4)	73 (44.5)
	60~79	569 (65.9)		135 (71.1)	434 (64.4)	258 (70.7)	92 (63.4)	84 (51.2)
	≥80	38 (4.4)		17 (8.9)	21 (3.1)	15 (4.1)	5 (3.4)	1 (0.6)
	Average		4.75 (<.001)	68.9±10.41	64.9±10.37	66.7±10.34	64.9±9.23	60.9±10.31	18.67 (<.001) a>b, c^†
Partner	Yes	679 (78.6)	5.13 (.023)	138 (72.6)	541 (80.3)	271 (74.2)	123 (84.8)	147 (89.6)	19.34 (<.001)
Partner	No	185 (21.4)	5.13 (.023)	52 (27.4)	133 (19.7)	94 (25.8)	22 (15.2)	17 (10.4)	19.34 (<.001)
Education	Non	75 (8.7)	9.84 (.020)	25 (13.2)	50 (7.4)	34 (9.3)	7 (4.8)	9 (5.5)	30.15 (<.001)
	High school	676 (78.2)		149 (78.4)	527 (78.2)	299 (81.9)	115 (79.3)	113 (68.9)
	University	94 (10.9)		14 (7.4)	80 (11.9)	27 (7.4)	20 (13.8)	33 (20.1)
	Postgraduate	19 (2.2)		2 (1.1)	17 (2.5)	5 (1.4)	3 (2.1)	9 (5.5)
Job	Yes	409 (47.3)	3.24 (.072)	79 (41.6)	330 (49.0)	141 (38.6)	81 (55.9)	108 (65.9)	37.08 (<.001)
Job	No	455 (52.7)	3.24 (.072)	111 (58.4)	344 (51.0)	224 (61.4)	64 (44.1)	56 (34.1)	37.08 (<.001)
Total income (10,000 won)	Average		-2.50 (.013)	2,673.8±2,743.26	3,218.3±2,624.89	2,790.2±2,385.61	3,542.4±2,762.36	3,884.5±2,836.79	11.59 (<.001) a<b, c^†
Number of chronic disease			1.87 (.061)	5.0±2.55	4.6±2.61	5.0±2.77	4.4±2.44	3.8±2.16	12.24 (<.001) a>c^†

^†Scheffé test.

Table 2

Health Behaviors of the Participants

Variables	Categories	Total (n=864)	Exercise practice			Exercise intensity
			χ² or F (p)	Non-exercise (n=190)	Exercise (n=674)	Walk (n=365)	Moderate exercise (n=145)	Vigorous exercise (n=164)	χ² or F (p)
			χ² or F (p)	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	χ² or F (p)
Medication compliance	Compliance	747 (86.5)	7.32 (.007)	153 (80.5)	594 (88.1)	324 (88.8)	129 (89.0)	141 (86.0)	0.99 (.617)
Medication compliance	Noncompliance	117 (13.5)	7.32 (.007)	37 (19.5)	80 (11.9)	41 (11.2)	16 (11.0)	23 (14.0)	0.99 (.617)
Smoking	Smoker	161 (18.6)	6.64 (.036)	47 (24.7)	114 (16.9)	50 (13.7)	29 (20.0)	35 (21.3)	25.07 (<.001)
	Nonsmoker	222 (25.7)		41 (21.6)	181 (26.9)	81 (22.2)	39 (26.9)	61 (37.2)
	Lifelong nonsmoker	481 (55.7)		102 (53.7)	379 (56.2)	234 (64.1)	77 (53.1)	68 (41.5)
Drinking	Drinker	478 (55.3)	19.97 (<.001)	82 (43.2)	396 (58.8)	186 (51.0)	92 (63.4)	118 (72.0)	30.25 (<.001)
	Nondrinker	109 (12.6)		39 (20.5)	70 (10.4)	35 (9.6)	17 (11.7)	18 (11.0)
	Lifelong nonsmoker	277 (32.1)		69 (36.3)	208 (30.9)	144 (39.5)	36 (24.8)	28 (17.1)
Diet	Regular	763 (88.3)	6.26 (.012)	158 (83.2)	605 (89.8)	331 (90.7)	132 (91.0)	142 (86.6)	2.39 (.302)
Diet	Irregular	101 (11.7)	6.26 (.012)	32 (16.8)	69 (10.2)	34 (9.3)	13 (9.0)	22 (13.4)	2.39 (.302)
BMI	Underweight	17 (2.0)	7.87 (.096)	4 (2.2)	13 (2.0)	10 (2.8)	1 (0.7)	2 (1.3)	10.70 (.219)
	Normal	274 (32.7)		70 (37.8)	204 (31.2)	123 (34.8)	34 (23.9)	47 (29.6)
	Overweight	258 (30.8)		42 (22.7)	216 (33.0)	106 (30.0)	55 (38.7)	55 (34.6)
	Obesity	258 (30.8)		60 (32.4)	198 (30.3)	104 (29.5)	46 (32.4)	48 (30.2)
	Extremely-obese	32 (3.8)		9 (4.9)	23 (3.5)	10 (2.8)	6 (4.2)	7 (4.4)
	Average		-0.85 (.391)	23.9±3.20	24.1±2.98	23.9±2.94	24.4±3.09	24.3±2.95	1.67 (.188)

Table 3

Utilization of Health Services

Variables	Categories	Total (n=864)	Exercise practice			Exercise intensity
			χ² (p)	Non-exercise (n=190)	Exercise (n=674)	Walk (n=365)	Moderate exercise (n=145)	Vigorous exercise (n=164)	χ² (p)
			χ² (p)	n (%)	n (%)	n (%)	n (%)	n (%)	χ² (p)
ER	Yes	105 (12.2)	0.96 (.326)	27 (14.2)	78 (11.6)	50 (13.7)	16 (11.0)	12 (7.3)	4.55 (.103)
ER	No	759 (87.8)	0.96 (.326)	173 (85.8)	596 (88.4)	315 (86.3)	129 (89.0)	152 (92.7)	4.55 (.103)
In-patient	Yes	175 (20.3)	12.74 (<.001)	58 (30.5)	125 (18.5)	77 (21.0)	23 (15.9)	25 (15.2)	4.65 (.325)
In-patient	No	681 (78.8)	12.74 (<.001)	132 (69.5)	549 (81.5)	288 (78.9)	122 (84.1)	139 (84.8)	4.65 (.325)

Table 4

The Number of Days of Health Services

	Between non-exer group and exer group
Variables	t-test				ANCOVA^†
	Non-exercise (n=190)	Exercise (n=674)	t	p	Non-exercise (n=190)	Exercise (n=674)	F	p
	M±SD	M±SD	t	p	M±SD	M±SD	F	p
ER (n=19, 57)	1.0±0.17	1.0±0.23	-0.23	.817	1.0±0.05	1.0±0.03	0.11	.739
Inpatient (n=41, 96)	15.5±13.18	10.9±18.72	1.42	.157	15.9±2.80	10.7±1.80	2.31	.130
Outpatient (n=190, 674)	29.3±29.88	22.4±21.67	3.01	.003	27.3±1.61	22.9±0.85	5.74	.017

	3 groups by exercise intensity
Variables	ANOVA					ANCOVA^†
	Walk (n=365)	Moderate exercise (n=145)	Vigorous exercise (n=164)	F	p	Walk (n=365)	Moderate exercise (n=145)	Vigorous exercise (n=164)	F	p
	M±SD	M±SD	M±SD	F	p	M±SD	M±SD	M±SD	F	p
ER (n=39, 10, 8)	1.0±0.27	1.0±0.00	1.0±0.00	0.71	.496	1.0±0.04	1.0±0.08	0.9±0.08	0.83	.440
Inpatient (n=59, 16, 21)	10.7±14.99	7.6±9.50	13.9±30.45	0.50	.604	10.7±2.53	7.8±4.77	13.8±4.45	0.42	.657
Outpatient (n=365, 145, 164)	23.1±21.95	24.4±23.08	18.9±19.37	2.97	.052	21.4±1.07	25.0±1.68	22.1±1.61	1.61	.200

^†Age, the number of chronic disease and total income-adjusted means±standard error.

Table 5

Health Expenditures

		Between non-exer group and exer group
Variables	Categories	t-test				ANCOVA^†
		Non-exercise (n=190)	Exercise (n=674)	t	p	Non-exercise (n=190)	Exercise (n=674)	F	p
		M±SD	M±SD	t	p	M±SD	M±SD	F	p
	Medication (monthly)	31,234.7±24,174.73	28,730.7±31,510.78	0.88	.378	29,708.5±2,364.65	29,162.5±1,245.91	0.88	.839
ER	Personnel expenses	73,091.9±95,705.60	49,934.1±6,5091.57	0.98	.336	72,857.8±17,542.71	50,012.2±9,992.36	1.25	.266
ER	Total (personnel+insurers) expenses	284,182.4±326,872.18	148,774.0±101,452.52	1.15	.284	298,588.9±65,273.90	144,341.2±35,727.99	4.22	.049
Inpatient	Personnel expenses	917,964.6±900,511.30	878,255.4±1,279,444.42	0.18	.857	927,343.7±191,242.22	874,249.8±122,897.76	0.05	.819
Inpatient	Total (personnel+insurers) expenses	2,609,640.2±2,185,425.87	2,510,475.7±2,862,952.12	0.17	.862	2,633,079.0±487,960.23	2,500,058.4±320,508.44	0.05	.823
Outpatient	Personnel expenses	11,895.9±17,649.35	16,421.6±26,860.69	-2.74	.006	12,795.6±1,828.37	16,166.8±965.90	2.63	.105
Outpatient	Total (personnel+insurers) expenses	24,403.3±31,829.01	25,483.4±30,233.42	-0.41	.680	25,116.6±2,319.27	25,273.0±1,250.90	0.00	.953
Individual total expenses1		1,393,766.7±1,757,129.41	1,073,657.3±1,311,799.94	2.33	.020	1,354,487.5±102,356.62	1,084,730.1±53,941.43	5.38	.021
Individual total expenses2		1,503,210.2±,1924,504.47	1,096,801.4±1,324,625.10	2.73	.007	1,456,657.0±106,251.84	1,109,924.7±55,994.19	8.25	.004

	3 groups by exercise intensity
Variables	ANOVA					ANCOVA^†
	Walk (n=365)	Moderate exercise (n=145)	Vigorous exercise (n=164)	F	p	Walk (n=365)	Moderate exercise (n=145)	Vigorous exercise (n=164)	F	p
	M±SD	M±SD	M±SD	F	p	M±SD	M±SD	M±SD	F	p
Individual total expenses1	1,093,994.6±1,255,401.97	1,090,986.2±1,531,817.26	1,013,073.2±1,227,865.47	0.23	.794	1,057,798.6±68,489.08	1,104,338.8±107,395.80	1,081,825.6±103,161.57	0.07	.933
Individual total expenses2	1,123,689.7±1,274,848.70	1,113,413.8±1,537,682.34	1,022,270.5±1,232,439.57	0.34	.709	1,085,623.4±69,127.65	1,128,073.5±108,397.13	1,094,030.1±104,123.43	0.05	.947

^†Age, The number of Chronic disease and Total income-adjusted means±standard error.

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