Direct diabetes-related healthcare expenditures in Slovenia: recent evolution and future projections based on population-level data.

OBJECTIVE: The burden of diabetes on individuals, healthcare systems, and society must be explored to improve and sustain diabetes care. With this aim, we estimated both past and future diabetes-related direct health expenditures in Slovenia. METHODS: Analysis of expenditures from the healthcare payer perspective during the 2019-2022 period was based on individual patient data on expenditures for seven groups of diabetes-related medical conditions from the population-level database of the Health Insurance Institute of Slovenia. Expenditure projections were prepared using the European Commission's methodology for budgetary projections. RESULTS: In the 2019-2022 period, average annual diabetes-related expenditures equaled €174.1 million (€1,108 per patient), with their average annual growth rate reaching 12.5%. Expenditures due to inpatient care (33%) and drugs used in diabetes (24%) had the highest shares. More than half of the expenditures were due to complications of diabetes. The diabetes-related expenditures as a share of GDP are projected to increase by 19.2% from 2019 to 2030, with slower yet continued growth up to 2050. CONCLUSIONS: Diabetes-related expenditures in Slovenia continue to rise. By focusing on the prevention and optimal management of diabetes, its impact on the healthcare system could be reduced significantly, given the magnitude of expenditures attributed to complications.

Diabetes is a chronic metabolic disease characterized by elevated blood sugar levels, leading to serious damage to the heart, blood vessels, eyes, kidneys, and nerves. The number of patients with diabetes has been increasing and accounted for about 10% of the world's population aged 20­79 years in 2021. Diabetes and its complications also represent a substantial economic burden for individuals, healthcare systems, and society. Using data extracted from the database of the Health Insurance Institute of Slovenia, we looked at the direct healthcare expenditures related to diabetes over the 2019­2022 period and estimated their future trends. During the observed period, the average annual diabetes-related expenditures from the healthcare payer perspective equaled €174.1 million (€1,108 per patient), with their average annual growth rate reaching 12.5%. Expenditures due to hospitalizations (33%) and drugs used in diabetes (24%) had the highest shares. More than half of the expenditures were due to the complications of diabetes. Diabetes-related expenditures as a share of GDP are projected to increase by 19.2% from 2019 to 2030, with slower yet continued growth up to 2050. Our results confirm the growing economic burden of diabetes in Slovenia. Given that modifiable risk factors significantly contribute to the development of diabetes, primary prevention programs to promote healthy lifestyles need to be strengthened. By improving the detection of diabetes and managing it optimally, the progression of the disease and the occurrence of its costly complications can also be prevented considerably.

Mortality, seasonal variation, and susceptibility to acute exacerbation of COPD in the pandemic year: a nationwide population study.

BACKGROUND: Previous studies have suggested that the coronavirus disease 2019 (COVID-19) pandemic was associated with a decreased rate of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Data on how the COVID-19 pandemic has influenced mortality, seasonality of, and susceptibility to AECOPD in the chronic obstructive pulmonary disease (COPD) population is scarce. METHODS: We conducted a national population-based retrospective study using data from the Health Insurance Institute of Slovenia from 2015 to February 2021, with 2015-2019 as the reference. We extracted patient and healthcare data for AECOPD, dividing AECOPD into severe, resulting in hospitalisation, and moderate, requiring outpatient care. The national COPD population was generated based on dispensed prescriptions of inhalation therapies, and moderate AECOPD events were analysed based on dispensed AECOPD medications. We extracted data on all-cause and non-COVID mortality. RESULTS: The numbers of severe and moderate AECOPD were reduced by 48% and 34%, respectively, in 2020. In the pandemic year, the seasonality of AECOPD was reversed, with a 1.5-fold higher number of severe AECOPD in summer compared to winter. The proportion of frequent exacerbators (⩾2 AECOPD hospitalisations per year) was reduced by 9% in 2020, with a 30% reduction in repeated severe AECOPD in frequent exacerbators and a 34% reduction in persistent frequent exacerbators (⩾2 AECOPD hospitalisations per year for 2 consecutive years) from 2019. The risk of two or more moderate AECOPD decreased by 43% in 2020. In the multivariate model, pandemic year follow-up was the only independent factor associated with a decreased risk for severe AECOPD (hazard ratio [HR]: 0.71; 95% confidence interval [CI]: 0.61-0.84; p < 0.0001). In 2020, non-COVID mortality decreased (-15%) and no excessive mortality was observed in the COPD population. CONCLUSION: In the pandemic year, we found decreased susceptibility to AECOPD across severity spectrum of COPD, reversed seasonal distribution of severe AECOPD and decreased non-COVID mortality in the COPD population.

A Quantitative Assessment of the Rush Hour of Life in Austria, Italy and Slovenia.

This article builds on time use data to explore cross-country differences between Austria, Italy and Slovenia in unpaid labour and its implications in terms of gender distribution of total work. A contribution of this paper is to measure the 'rush hour of life' (RHOL) based on age spans in which individuals' working time (including paid and unpaid work) exceeds their free time. In total, men and women work similar hours in Austria, whereas Italy and Slovenia show a gender gap with women working an average of approximately 50 min more per day during prime working ages. The different compositions and loads of total work are reflected in cross-country variations of the length and intensity of the RHOL, with Slovenian women reporting, on average, the larger squeeze of time. However, breadwinner arrangements differ considerably among the three countries, which can affect the amounts of work and free time available for men and even more so for women. Therefore, we further extend our analysis by developing a regression model to quantitatively assess the association between couples' working arrangements and levels of the RHOL indicator for men and women. Results indicate a dual burden for women in dual-earner couples, squeezing out their free time. By contrast, women in male-breadwinner arrangements report the lowest amounts of total work. Breadwinner models show no significant relation to male levels of work and free time, with the main exception of Italy where men face higher RHOL in full-time employed couples.

Longevity in Slovenia: Past and potential gains in life expectancy by age and causes of death.

INTRODUCTION: In Slovenia, longevity is increasing rapidly. From 1997 to 2014, life expectancy at birth increased by 7 and 5 years for men and women, respectively. This paper explores how this gain in life expectancy at birth can be attributed to reduced mortality from five major groups of causes of death by 5-year age groups. It also estimates potential future gains in life expectancy at birth. METHODS: The importance of the five major causes of death was analysed by cause-elimination life tables. The total elimination of individual causes of death and a partial hypothetical adjustment of mortality to Spanish levels were analysed, along with age and cause decomposition (Pollard). RESULTS: During the 1997-2014 period, the increase in life expectancy at birth was due to lower mortality from circulatory diseases (ages above 60, both genders), as well as from lower mortality from neoplasms (ages above 50 years) and external causes (between 20 and 50 years) for men. However, considering the potential future gains in life expectancy at birth, by far the strongest effect can be attributed to lower mortality due to circulatory diseases for both genders. If Spanish mortality rates were reached, life expectancy at birth would increase by more than 2 years, again mainly because of lower mortality from circulatory diseases in very old ages. DISCUSSION AND CONCLUSIONS: Life expectancy analyses can improve evidence-based decision-making and allocation of resources among different prevention programmes and measures for more effective disease management that can also reduce the economic burden of chronic diseases.

Quantifying Economic Dependency.

In this paper we compare several types of economic dependency ratios for a selection of European countries. These dependency ratios take into account not only the demographic structure of the population, but also the differences in age-specific economic behaviour such as labour market activity, income and consumption as well as age-specific public transfers. In selected simulations where we combine patterns of age-specific economic behaviour and transfers with population projections, we show that in all countries population ageing would lead to a pronounced increase in dependency ratios if present age-specific patterns were not to change. Our analysis of cross-country differences in economic dependency demonstrates that these differences are driven by both differences in age-specific economic behaviour and in the age composition of the populations. The choice of which dependency ratio to use in a specific policy context is determined by the nature of the question to be answered. The comparison of our various dependency ratios across countries gives insights into which strategies might be effective in mitigating the expected increase in economic dependency due to demographic change.