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Hospitalization risk in a type 2 diabetes cohort
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by Edward Ng, Kimberlyn M. McGrail and Jeffrey A. Johnson
Abstract
Keywords
Findings
Authors
What is already known on this subject?
What does this study add?
Abstract
Background
Using a health outcome research framework, the hospitalization risk for a type 2 diabetes (T2DM) cohort is evaluated. Diabetes is “ambulatory care sensitive”― a condition largely manageable with appropriate care in the community. Thus, hospitalization may represent a negative care outcome.
Data and methods
Analyses were conducted by linking data from the Canadian Community Health Survey (CCHS) cycle 1.1 to the Canadian Hospital Morbidity Database for respondents identified as having T2DM. Logistic regression was used to examine the association between the likelihood of all-cause hospitalization within two years of the survey date and patients’ characteristics, care path, and health system characteristics.
Results
When the effects of demographic, socio-economic and health status characteristics were taken into account, physical inactivity and former or current smoking were significantly associated with an increased likelihood of hospitalization for those with type 2 diabetes. Specialist visits were positively related to hospitalization (OR=1.4), whereas the relationship with general practitioner visits was negative (OR=0.7). Regional hospital use patterns were significantly associated with hospitalization (OR=2.6).
Interpretation
Regional patterns of hospital use are important for hospitalization: T2DM residents of health regions with generally higher hospitalization rates were more likely to be hospitalized than were those living elsewhere. In terms of care path, GP consultations were associated with a lower risk of hospitalization. Specialist consultations, likely a marker of disease severity, had the reverse effect.
Keywords
databases, health services research, health surveys, hospital records, inpatient, outcome assessment, probabilistic linkage
Findings
In recent years, diabetes-related mortality has increased, an increase that has been linked to an upturn in the prevalence of obesity. Diabetes is currently the sixth leading cause of death in Canada. In 2005, approximately 1.3 million Canadians aged 12 or older (5% of the population in that age range) reported that they had been diagnosed with the disease. The complications of diabetes can attack every major organ. Because of its wide-ranging impact on the health of individuals and the economic burden it places on the health care system, diabetes is recognized as a major public health problem.[Full text]
Authors
Edward Ng (1-613-951-5308; edward.ng@statcan.gc.ca) and Kimberlyn M. McGrail are with the Health Analysis Division at Statistitics Canada, Ottawa, Ontario, K1A 0T6. Kimberlyn M. McGrail is also with the School of Population and Public Health, University of British Columbia. Jeffrey A. Johnson is with the School of Public Health, University of Alberta.
What is already known on this subject?
- Diabetes is “ambulatory care sensitive”—a condition largely manageable with appropriate community care.
- Well-known risk factors like smoking, drinking, and physical activity are important in managing the disease.
- Much less is known about the roles of GPs and specialists in the risk of hospitalization of people with diabetes.
- Regional variations in the use of health care services suggest that an individual’s likelihood of hospitalization may, in part, reflect where he or she lives.
What does this study add?
- Data from the 2000/2001 Canadian Community Health Survey were linked with data from the Hospital Morbidity Database to determine care path and health system factors related to the likelihood that people with type 2 diabetes would be hospitalized over the subsequent two years.
- Among people with type 2 diabetes, consultation with a specialist was associated with a higher risk of hospitalization; this was likely a marker of disease severity.
- Regional hospital utilization patterns were highly significant for all-cause hospitalization.
