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ABSTRACT
Objective
To characterize the impact of comorbidities, including number and types, on hospitalization
and emergency room (ER) visits in people with diabetes.
Methods
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.
Results
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.
Conclusions
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.
Keywords
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Article info
Publication history
Accepted:
February 20,
2023
Received in revised form:
January 17,
2023
Received:
September 14,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Key Messages: Comorbidities in people with diabetes often lead to worse health outcomes. Our study shows that i) the number of comorbidities was the key determinant of health services use for people with diabetes; ii) Diabetes-related vascular diseases (e.g. CVD), obesity-related conditions (e.g. 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.
Author Disclosures: The authors declared no conflict of interest.
Identification
Copyright
© 2023 Canadian Diabetes Association.
