Original Research|Articles in Press

Impact of Co-morbidity on Hospitalization and Emergency Room Visits in People with Diabetes: A Longitudinal Study of Alberta’s Tomorrow Project

Published:February 26, 2023DOI:
      This paper is only available as a PDF. To read, Please Download here.



      To characterize the impact of comorbidities, including number and types, on hospitalization and emergency room (ER) visits in people with diabetes.


      Incident cases of diabetes from Alberta’s Tomorrow Project (ATP) with over 24 months of follow-up were included. Comorbidities, classified by Elixhauser conditions, were updated every 12-months after diagnosis. A generalized estimating equation (GEE) model was used to examine the association [by Incident Rate Ratio (IRR)] between time-varying comorbidity profile and hospitalization and ER visits per year of follow-up after adjusting for socio-demographic factors, lifestyle behaviors and historical healthcare utilization in the past five years.


      Among 2,110 incident cases of diabetes (51.0% females, median age at diagnosis= 59.5, median follow-up = 7.19 years), the average number of Elixhauser comorbidities was 1.9±1.6 in the first year of diagnosis and 3.3±2.0 in the 15th year after diagnosis. The number of comorbidities in the previous year was positively associated with risk of hospitalization [IRR =1.33 (1.04-1.70) and 2.14 (1.67-2.74) for 1-2 and 2+ comorbidities, respectively] and ER visits [IRR=1.31 (1.15-1.50) and 1.62 (1.41-1.87) for 1-2 and 2+ comorbidities, respectively] in the subsequent year. Cardiovascular diseases, peripheral vascular diseases, cancer, liver disease, fluid and electrolyte disorders and depression, were major conditions associated with increased healthcare utilization.


      The number of comorbidities was an important risk factor of healthcare utilization for people with diabetes. Vascular diseases, cancer and conditions highly related to diabetic frailty (e.g. fluid and electrolyte disorders and depression), were the main drivers of hospital care and ER visits.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Canadian Journal of Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect