Acute diarrhea, a significant burden to Thailand’s universal health care system: a nationwide database
, , and | Mar 31, 2017
About this article
Article Category: Original article
Published Online: Mar 31, 2017
Page range: s23 - s30
DOI: https://doi.org/10.5372/1905-7415.1000.518
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© 2016 Sombat Treeprasertsuk, Kaewjai Thepsuthammarat, Bubpha Kitsahawong, Kamthorn Phaosawasdi
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
The disease outcome including the mortality rate and complications of patients with acute diarrhea classified into 3 groups according to their health insurance from the 2010 Nationwide Hospital Admission Data of Thailand
| Group of patients with acute diarrhea (Total = 214,722 admissions) | Universal Coverage (UC) (n = 154,582) | Social Security Fund (SSF) (n = 32,402) | Civil Servant Medical Benefits Scheme (CSMBS)(n = 27,738) | P |
|---|---|---|---|---|
| Outcome: death n (%) | 859 (0.6%) | 31 (0.1%) | 158 (0.6%) | <0.001 |
| Complications n (%) | ||||
| Infection following procedures | 19 (0.0%) | 2 (0.0%) | 4 (04 (0.0%) | |
| Septicemia | 3943 (2.6%) | 145 (0.4%) | 587 (2.1%) | |
| AKI Requiring HD | 121 (0.1%) | 26 (0.1%) | 147 (0.5%) | |
| Respiratory failure on ventilator <96 h | 627 (0.4%) | 18 (0.1%) | 209 (0.8%) | |
| Respiratory failure on ventilator ≥96 h | 224 (0.1%) | 11 (0.0%) | 160 (0.6%) | |
| Length of stay (days) | 2.3 ± 2.4 | 2.7 ±1.7 | 3.7 ± 5.9 | <0.001 |
| Length of stay >3 days (%) | 13.6% | 15% | 34.4% | <0.001 |
| Hospital charge (baht) 1 Thai baht equals about 0.03316 USD (December 31, 2010 US Federal Statistical Release year end; rate fluctuates daily) | 3529 ±8199 | 6507 ±9881 | 5387 ± 20870 | <0.001 |
The baseline characteristics and the comorbidities of patients with acute diarrhea classified into 3 groups according to their health insurance from the 2010 Nationwide Hospital Admission Data of Thailand
| Group of patients with acute diarrhea (Total = 214,722 admissions) | Universal Coverage (UC) (n = 154,582) | Social Security Fund (SSF) (n = 32,402) | Civil Servant Medical Benefits Scheme (CSMBS)(n = 27,738) | P |
|---|---|---|---|---|
| Age, mean (SD) years | 55.8 (18.7) | 35 (10.5) | 63.8 (16.6) | <0.001 |
| Age >60 years (%) | 45.3% | 2% | 60.9% | <0.001 |
| Sex (%female) | 63.7% | 64.2% | 62.7% | >0.05 |
| Hospital (H) level (%) | <0.001 | |||
| Community H. | 75.7 | 2.5 | 62.3 | |
| General H. | 14.0 | 16.7 | 21.3 | |
| Tertiary care H. | 7.6 | 14.6 | 16.2 | |
| Private H. | 2.7 | 66.2 | 0.2 | |
| Region | <0.001 | |||
| Central | 26% | 75% | 30.9% | |
| Northeast | 40% | 10% | 35.6% | |
| Other | 34% | 15% | 33.5% | |
| Comorbidities | ||||
| Atherosclerotic heart disease | 0.2% | 0.1% | 0.6% | |
| Congestive heart failure | 0.7% | 0.1% | 0.7% | |
| COPD | 1.5% | 0.1% | 1.5% | |
| Diabetes Mellitus | 0.2% | 0.3% | 0.4% | |
| Stroke | 0.1% | 0.0% | 0.2% |
The diarrheal disease burden and the pathogens
| Authors, year/country | Number of patients with acute diarrhea | Age mean (SD) | Pathogen |
|---|---|---|---|
| Thomas et al., 2013/ Canada [ | 4.0 Million episodes/year of domestically acquired foodborne illness in 2006 | No data | Norovirus (1 million), |
| Wilking et al., 2013/Germany [ | 0.95 Episodes/person per year during 2008–2009 or 64·9 million episodes/year | Median age 46 years (IQR, 35–60 years) | 13.8% of population provided stool sample tests |
| Hou et al., 2013/China[ | n= 800 in 20 hospitals (Beijing, Shaanxi), in 2001 | 37.0 (16.3) years | Stool culture for |
Result of stool culture for bacteria during the 10-year period (2004–2013) from Vichaiyut hospital, Bangkok. Thailand (local data)
| Data from 2004-2014 (n = 10,931) n (% of stool culture of patients with acute diarrhea) | Data 2010 (n = 1,270) n (% of stool culture of patients with acute diarrhea) | |
|---|---|---|
| 711 (6.5%) | 91 (7.2%) | |
| 573 (5.3%) | 92 (7.2%) | |
| 538 (4.9%) | 70 (5.5%) | |
| 504 (4.6%) | 73 (5.7%) | |
| 23 (0.21%) | 4 (0.3%) | |
| 9 (0.09%) | - | |
| 5 (0.05%) | 1 (0.1%) | |
| 2 (0.02%) | - | |
Multivariate logistic regression model showing odds ratios (OR) (95% confidence intervals, CI) of predictors for death in patients with acute diarrhea from the 2010 Nationwide Hospital Admission Data of Thailand.
| Multivariate analysis; variables | OR | 95% CI | P |
|---|---|---|---|
| Hospital level | |||
| Secondary + Tertiary | 2.9 | 1.8–4.6 | <0.001 |
| Primary | 0.6 | 0.4–1.0 | |
| Private | 1 | ||
| Region | |||
| Central | 1.94 | ||
| Northern | 1.27 | 1.5–2.6 | <0.001 |
| Northeast | 0.80 | 0.9–1.7 | >0.05 |
| Southern | 1 | 0.6–1.1 | >0.05 |
| Insurance Group | |||
| Universal Coverage | 3.1 | 1.9–4.8 | <0.001 |
| Government Welfare Medical Expense | 2.6 | 1.6–4.2 | |
| Social Security Fund | 1 | ||
| Sex, male | 1.6 | 1.4–1.9 | <0.001 |
| Age on admission >60 years old | 1.8 | 1.52.2 | <0.001 |
| Length of stay >3 days | 0.8 | 0.7–1.02 | >0.05 |
| Complications | |||
| Congestive heart failure | 2.7 | 1.6–4.5 | <0.001 |
| Septicemia | 20.2 | 16.5–24.9 | <0.001 |
| Respiratory failure requiring continuous invasive mechanical ventilation | 31.3 | 24.8–39.4 | <0.001 |