Type 2 diabetes in Vietnam: a cross-sectional, prevalence-based cost-of-illness study

Figures & data

Table 1 Socio-demographic and clinical characteristics of patients with diabetes mellitus in Vietnam (2016, n=392)

Patients’ characteristics	n (%)
Age, years
Mean (SD)	65.14 (13.45)
Median (Q1–Q3)	64.0 (56–72.7)
Age groups (years)
<40	11 (2.8)
40–49	38 (9.7)
50–59	83 (21.2)
60–69	119 (30.4)
70–79	73 (18.6)
≥80	68 (17.3)
Gender
Male	131 (33.4)
Female	261 (66.6)
Duration of diabetes in years
1–5	10 (2.6)
6–10	144 (36.7)
11–15	115 (29.3)
16–20	40 (10.2)
≥21	8 (2.0)
Glycemic control (mg/dL)
70–130	152 (33.8)
131–179	168 (42.9)
≥180	72 (18.4)
Complications
Without complication	133 (38.4)
With complication	259 (69.6)
Number of complications (median, Q1–Q3)	2 (1–4)
Comorbidities
Without comorbidity	10 (2.6)
With comorbidity	382 (97.4)
Number of comorbidities (median, Q1–Q3)	7 (3–11)
Department
OPD	345 (88.0)
IPD	47 (12.0)
Health insurance status
80%	315 (80.4)
95%	7 (1.8)
100%	70 (17.9)
BMI
<18.5	49 (12.5)
18.5–22.9	105 (26.8)
23–26.9	127 (32.4)
≥27	102 (26.0)
Treatment drug
Insulin and OAD	8 (2.0)
OAD	384 (98.0)
Marriage status
Single	33 (8.4)
Married	315 (80.4)
Divorced/Widow	44 (11.2)
Education *
Low	84 (21.4)
Middle	236 (60.2)
High	72 (18.4)
Occupation
Labor	74 (18.9)
Govt. officials	16 (4.1)
Business	22 (5.6)
Housewife	73 (18.6)
Unemployed	39 (9.9)
Retired	52 (13.3)
Others	116 (29.6)
Monthly income
<$200	208 (53.0)
$200–$399	23 (5.9)
$400–$499	27 (6.8)
$500–$599	10 (2.5)
$600–$699	12 (3.1)
No income	112 (28.6)
Impact on income
Yes	146 (37.2)
Loan	67 (17.1)
Sell property	2 (0.5)
Others	77 (19.6)
No	246 (62.8)
Curtailment of expenditure	185 (47.2)
Saving money	61 (15.5)
Lifestyle
Drinking	22 (5.6)
Smoking	16 (4.1)
Exercising	268 (68.4)
Relatives’ T2DM history
Yes	111 (28.3)
No	281 (71.7)
Transportation
Motorcycle	266 (67.9)
Car	5 (1.2)
Taxi	3 (0.8)
Motorcycle rider	9 (2.3)
Bus	109 (27.8)

Note:

* Low: none and primary school; Middle: lower and upper secondary school; High: diploma or Bachelor’s degree or postgraduation. Data presented as number (percentage) unless stated otherwise.

Abbreviations: BMI, body mass index; IPD: inpatients department; OAD, oral antidiabetics; OPD: outpatients department; SD, standard deviation; T2DM, type 2 diabetes mellitus.

Table 2 Prevalence of complications and comorbidities among patients with T2DM in Vietnam (2016, n=392)

	Whole sample	Gender		p-value*	Spearman’s rho**
	(n=392)	Female (n=261)	Male (n=131)		ρ	p-value
Complications
Microvascular	79 (18.2)	52 (19.9)	27 (20.6)	0.002	0.10	0.777
Macrovascular	37 (8.5)	19 (7.3)	18 (13.7)		0.78	0.008
Microvascular and macrovascular	143 (32.9)	109 (41.8)	34 (26.0)		0.81	0.005
Number of comorbidities
None	10 (2.6)	5 (1.9)	5 (3.8)	0.006
One	29 (7.4)	18 (6.9)	11 (8.4)
Two	41 (10.5)	19 (7.3)	22 (16.8)
Three	37 (9.4)	30 (11.5)	7 (5.3)
Four or more	275 (70.2)	189 (72.4)	86 (65.6)
(ICD-10) Comorbidities
(E66) Obesity	102 (26.0)	64 (16.3)	38 (9.7)	0.026	−0.22	0.533
(E78) Disorders of lipoprotein metabolism	295 (75.3)	205 (78.5)	90 (68.7)	0.035	0.42	0.229
(H81) Disorders of vestibular function	168 (42.9)	129 (49.4)	39 (29.8)	<0.001	0.68	0.029
(I10) Hypertension	302 (77.0)	207 (79.3)	95 (72.5)	0.128	0.68	0.029
(J31–J32) Chronic diseases of upper respiratory system	111 (28.3)	83 (31.8)	28 (21.4)	0.011	0.28	0.425
(J45) Asthma	129 (32.9)	89 (34.1)	40 (30.5)	0.434	0.75	0.013
(K29) Gastritis/duodenitis	180 (45.9)	129 (49.4)	51 (38.9)	0.031	0.65	0.043
(K70–K77) Diseases of liver	149 (38.0)	91 (34.9)	58 (44.3)	0.058	0.20	0.579

Notes:

* p-value of the Chi-square test;

** Spearman’s test value (ρ is the correlation and p is the p-value of ρ). Data presented as number (percentage).

Figure 1 Spearman’s rank correlation coefficient of complications and comorbidity associated with age

Abbreviation: Mic, microvascular; Mac, macrovascular.

Table 3 Details of total cost per annum in USD for management of diabetes in Vietnam (2016, USD)

Patients’ characteristics	Direct cost		Indirect cost	Total cost
	Direct medical cost	Direct nonmedical cost
	Arithmetic mean (bootstrap 95% CI)			Median	Arithmetic mean (bootstrap 95% CI)
Age groups (years)
≤39	67.9 (19.4, 162.6)	36.1 (21.7, 54.6)	103.7 (71.4, 155.9)	136.4	207.7 (130.1, 354.9)
40–49	57.1 (31.9, 115.2)	34.1 (25.0, 47.3)	81.1 (66.8, 98.7)	145.7	172.3 (139.4, 216.9)
50–59	97.0 (66.3, 147.4)	33.5 (25.9, 43.2)	89.2 (77.6, 103.8)	172.2	219.7 (189.6, 262.3)
60–69	180.1 (145.7, 228.2)	33.0 (26.9, 40.7)	84.6 (73.7, 100.7)	216.5	297.7 (257.6, 350.7)
70–79	149.4 (109.4, 194.7)	37.1 (29.5, 47.3)	79.9 (69.2, 92.6)	233.8	266.4 (227.6, 314.2)
≥80	97.0 (76.2, 127.8)	34.7 (26.8, 44.6)	81.9 (69.5, 100.2)	172.8	213.6 (182.1, 254.5)
Gender
Male	94.5 (73.6, 128.2)	29.5 (24.4, 35.9)	89.5 (80.3, 101.5)	162.3	213.5 (188.2, 246.7)
Female	143.8 (123.1, 167.9)	36.8 (32.3, 41.9)	81.9 (75.0, 90.6)	189.8	262.5 (238.6, 290.9)
Duration of diabetes in years
1–5	112.0 (57.6, 168.1)	35.7 (17.7, 63.2)	87.0 (56.8, 132.9)	218.9	234.7 (166.7, 303.8)
6–10	125.7 (100.3, 160.2)	32.5 (27.3, 38.6)	85.2 (75.8, 97.8)	176.4	243.4 (214.9, 281.0)
11–15	128.7 (103.7, 160.1)	36.1 (29.5, 44.3)	80.5 (71.4, 91.1)	194.9	245.3 (215.7, 280.1)
16–20	115.2 (71.5, 207.6)	35.2 (24.3, 49.7)	84.5 (69.4, 104.0)	176.5	234.9 (187.0, 307.4)
≥21	174.4 (64.3, 300.9)	35.9 (13.3, 91.0)	113.9 (58.9, 268.7)	204.3	324.2 (154.4, 535.1)
Glycemic control (mg/dL)
70–130	90.3 (68.8, 117.9)	36.1 (30.4, 42.6)	80.6 (73.1, 90.0)	151.1	207.0 (182.6, 241.4)
131–179	141.7 (118.7, 174.6)	35.0 (29.6, 41.2)	81.1 (72.2, 93.1)	204.8	257.8 (232.1, 289.9)
≥180	171.8 (129.4, 262.8)	29.3 (22.8, 38.6)	100.3 (86.6, 115.3)	242.5	301.4 (255.0, 370.1)
BMI
<18.5	91.1 (64.4, 147.0)	29.3 (20.1, 43.1)	87.8 (69.9, 115.7)	170.7	208.2 (175.9, 261.7)
18.5–22.9	144.1 (111.0, 198.6)	39.3 (32.4, 47.2)	82.8 (72.7, 96.1)	204.4	266.2 (231.0, 314.8)
23–26.9	124.7 (100.1, 158.1)	33.7 (27.9, 40.6)	85.3 (76.0, 97.8)	168.2	243.7 (211.5, 284.5)
≥27	132.6 (100.9, 176.4)	32.6 (26.0, 40.5)	82.9 (72.8, 95.6)	191.8	248.1 (215.9, 290.4)
Treatment type
OAD	117.4 (102.1, 135.7)	34.4 (30.8, 38.2)	84.4 (78.8, 91.3)	187.0	236.2 (227.9, 268.0)
Insulin and OAD	548.3 (354.3, 845.0)	42.7 (20.7, 88.3)	90.8 (55.5, 149.9)	557.9	681.8 (484.2, 954.2)
Education
Low	123.1 (88.9, 189.1)	33.3 (25.9, 43.3)	80.5 (70.1, 95.4)	186.5	236.9 (201.4, 292.7)
Middle	137.0 (115.4, 165.1)	35.2 (30.7, 40.3)	87.2 (79.8, 96.0)	198.4	259.4 (234.9, 287.4)
High	100.3 (76.1, 130.3)	32.9 (25.8, 42.3)	79.8 (68.6, 100.3)	150.2	213.0 (180.0, 254.6)
Complications
Microvascular	143.1 (107.5, 204.6)	36.0 (29.2, 44.1)	81.3 (71.3, 92.8)	209.3	260.4 (220.9, 322.7)
Macrovascular	81.8 (50.9, 131.1)	35.4 (23.6, 52.9)	80.3 (67.1, 95.1)	166.6	197.5 (156.0, 246.1)
Microvascular and macrovascular	227.8 (199.1, 262.8)	34.8 (29.0, 42.0)	86.8 (76.3, 100.3)	319.7	349.4 (317.0, 389.7)
ICD-10
(E66) Obesity	132.6 (103.7, 175.1)	32.6 (26.1, 41.0)	82.9 (73.4, 96.2)	191.8	248.1 (215.4, 290.6)
(E78) Disorders of lipoprotein metabolism	157.8 (138.0, 182.6)	33.7 (29.9, 38.2)	85.2 (78.2, 93.5)	216.5	276.7 (254.4, 302.6)
(H81) Disorders of vestibular function	214.0 (185.0, 251.0)	33.8 (28.7, 39.7)	85.0 (76.1, 97.2)	275.6	332.8 (299.6, 371.8)
(I10) Hypertension	153.6 (133.6, 178.9)	35.4 (31.2, 40.0)	82.8 (76.5, 90.2)	213.0	271.8 (250.4, 298.0)
(J31–J32) Chronic diseases of upper respiratory system	231.2 (194.9, 276.6)	32.6 (26.8, 39.8)	84.6 (73.9, 99.2)	293.4	348.4 (308.9, 396.3)
(J45) Asthma	198.5 (167.4, 238.6)	31.0 (25.7, 37.3)	90.8 (80.2, 103.9)	281.9	320.3 (284.8, 362.5)
(K29) Gastritis/duodenitis	187.1 (160.4, 220.1)	31.5 (26.9, 36.7)	87.0 (77.8, 98.0)	256.3	305.6 (276.2, 341.1)
(K70–K77) Diseases of liver	208.8 (179.3, 245.8)	35.9 (30.3, 42.8)	91.0 (80.5, 105.4)	289.6	335.7 (302.9, 375.6)
(M47) Spondylosis	240.2 (199.1, 292.5)	35.4 (29.3, 42.8)	80.9 (71.2, 94.6)	298.2	356.5 (311.9, 411.5)

Abbreviations: BMI, body mass index; OAD, oral antidiabetics.

Table 4 Mean cost statistically significantly difference between groups in Vietnam (2016, USD)

Patients’ characteristics		Mean difference between 2 groups	95% CI
Age groups (years)
40–49	60–69 70–79	−125.4 −94.1	(−211.7, −24.1) (−165.9, −19.8)
50–59	60–69	−78.0	(−142.9, −15.3)
60–69	≥80	84.1	(29.3, 136.7)
Gender
Male	Female	−48.9	(−95.0, −3.1)
Duration of diabetes in years
6–10	≥21	−81.0	(−135.3, −24.2)
11–15	≥21	−78.9	(−140.3, −23.3)
Glycemic control (mg/dL)
70–130	131–179 ≥180	−50.8 −94.4	(−88.3, −8.2) (−137.0, −44.2)
Treatment type
Insulin and OAD	OAD	445.9	(181.2, 690.6)
Education
Middle	High	46.4	(12.3, 79.2)
Complications
Microvascular	Macrovascular Microvascular and macrovascular	62.9 −89.0	(4.8, 117.0) (−155.8, −19.0)
Macrovascular	Microvascular and macrovascular	−151.9	(−230.2, −64.3)
(ICD-10) Comorbidities
(E66) Obesity	(H81) Disorders of vestibular function (J31–J31) Chronic diseases of upper respiratory system (J45) Asthma (K29) Gastritis/duodenitis (K70–K77) Diseases of liver (M47) Spondylosis	−84.7 −100.3 −72.3 −57.5 −87.6 −108.5	(−142.7, −29.1) (−156.0, −41.4) (−125.7, −17.4) (−113.6, −1.9) (−147.4, −30.7) (−169.1, −44.1)
(E78) Disorders of lipoprotein metabolism	(H81) Disorders of vestibular function (J31–J31) Chronic diseases of upper respiratory system (J45) Asthma (K70–K77) Diseases of liver (M47) Spondylosis	−56.1 −71.8 −43.8 −59.1 −80.0	(−94.1, −19.3) (−107.0, −33.0) (−79.6, −10.0) (−94.8, −23.3) (−117.1, −41.2)
(I10) Hypertension	(J31–J31) Chronic diseases of upper respiratory system (J45) Asthma (K70–K77)Diseases of liver (M47) Spondylosis	−76.6 −48.6 −63.9 −84.8	(−110.9, −42.9) (−84.9, −15.5) (−98.3, −30.2) (−122.4, −43.7)

Abbreviation: OAD, oral antidiabetics.

Table

Cost components	Total treatment (% of total cost of illness)	Arithmetic mean	Bootstrap 95% CI
Direct medical cost
Medical Care	4460.6 (4.6)	11.4	(8.5, 15.6)
Diagnosis	4680.2 (4.9)	15.1	(13.4, 17.1)
Operation	12,323.3 (12.7)	77.0	(59.9, 103.6)
Pharmaceutical	26506.4 (27.5)	67.6	(58.9, 77.9)
Medical supplement	1925.9 (2.0)	5.6	(4.2, 10.7)
Total direct medical cost	49,896.4 (51.7)	127.3	(111.3, 147.1)
Direct non-medical cost
Transportation	13,470.0 (14.0)	34.4	(30.9, 38.3)
Indirect cost
Absenteeism cost	20,179.0 (20.9)	67.0	(63.4, 71.1)
Presenteeism	8408.2 (8.7)	113.6	(107.5, 123.1)
Reduced productivity for those not in the workforce	4507.5 (4.7)	49.5	(44.7, 55.9)
Total indirect cost	33,094.8 (34.3)	84.4	(78.8, 91.1)
Total cost of illness	96,461.1 (100.0)	246.1	(228.3, 267.2)

Note: Bold data is the total cost of each cost type

Table

Machine learning algorithms	R ^2 score	MSE
Generalized linear models
Ordinary least squares	63.71	0.985
Ridge Regression	63.83	0.982
Lasso Regression	64.32	0.968
Ensemble methods
Random forest	63.58	0.988
Gradient boosting	65.42	0.938
ADA boosting	64.86	0.954
Extra trees	63.38	0.994

Note:R ² score: Higher is better. MSE (mean square error): Lower is better. Bold data is the fittest model in each models.

Abbreviation: ADA, adaptive.

Figure 2 The percentage of covariances that contribute to the cost of treatment. ^aHistory of Type 2 diabetes of relative.

Abbreviation: BMI, body mass index.

Figure 3 Standardized coefficient of Lasso Regression covariates

Note:^aHistory of Type 2 diabetes of relative.
Abbreviation: BMI, body mass index.