Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada.
Can J Diabetes. 2016 Feb;40(1):35-42. doi: 10.1016/j.jcjd.2015.09.002. Epub 2016 Jan 6.
Diabetes frequently coexists with other conditions, resulting in poorer diabetes self-management and quality of life, higher risk for diabetes-related complications and higher health service use compared to those with diabetes only. Few Canadian studies have undertaken a comprehensive, population-level analysis of comorbidity and health service utilization by older adults with diabetes. This study examined comorbidity and its association with a broad range of health services in a cohort of community-dwelling older adults with diabetes in Ontario, Canada.
We linked multiple administrative databases to create a cohort of 448,736 older adults with diabetes, described their comorbidities and obtained their 1-year use of health services (physician visits, emergency department visits, inpatient hospital admissions, home care use, nursing home admissions). We examined comorbidity patterns by age and gender and estimated the prevalence of 20 comorbid conditions and the most common condition clusters. The association between number of comorbidities and health service use was also examined.
More than 90% of the cohort had at least 1 comorbid condition. The number of comorbidities increased with age for both genders, and hypertension was the most common, affecting 79.1% of the cohort. Other common conditions included other cardiovascular conditions, ischemic heart disease, arthritis and anxiety. Utilization of all health services increased with the number of comorbid conditions.
Health service use was driven by the number of comorbid conditions, including diabetes and nondiabetes-related conditions, highlighting the importance of aligning diabetes care plans with patients' comorbidities.
糖尿病常与其他疾病共存，与仅患有糖尿病的患者相比，其自我管理和生活质量更差，发生糖尿病相关并发症和使用卫生服务的风险更高。加拿大的少数研究对伴有合并症的老年糖尿病患者进行了全面的、人群层面的分析，并对其卫生服务使用情况进行了分析。本研究在加拿大安大略省的一个社区居住的老年糖尿病患者队列中，检查了合并症及其与广泛的卫生服务的关联。
我们将多个管理数据库进行链接，创建了一个由 448736 名老年糖尿病患者组成的队列，描述了他们的合并症，并获得了他们 1 年的卫生服务使用情况（医生就诊、急诊就诊、住院、家庭护理使用、疗养院入院）。我们根据年龄和性别检查了合并症模式，并估计了 20 种合并症和最常见的合并症群的患病率。还检查了合并症数量与卫生服务使用之间的关联。
超过 90%的队列至少有一种合并症。两性的合并症数量均随年龄增长而增加，高血压是最常见的，影响了 79.1%的队列。其他常见疾病包括其他心血管疾病、缺血性心脏病、关节炎和焦虑症。随着合并症数量的增加，所有卫生服务的利用率都有所增加。
卫生服务的使用受到合并症数量的驱动，包括糖尿病和非糖尿病相关疾病，这突出了使糖尿病护理计划与患者合并症相匹配的重要性。
