安大略省和纽芬兰与拉布拉多省儿科到成人医疗过渡时期的急性糖尿病并发症：一项基于人群的队列研究。
Acute diabetes complications across transition from pediatric to adult care in Ontario and Newfoundland and Labrador: a population-based cohort study.
机构信息
Department of Pediatrics (Shulman, Guttmann), The Hospital for Sick Children, University of Toronto; ICES (Shulman, Fu, Guttmann); Institute for Health Policy, Management and Evaluation (Shulman, Guttmann), University of Toronto, Toronto, Ont.; Faculty of Medicine (Knight, Chafe), Memorial University of Newfoundland, St. John's, Nfld.
出版信息
CMAJ Open. 2020 Feb 11;8(1):E69-E74. doi: 10.9778/cmajo.20190019. Print 2020 Jan-Mar.
BACKGROUND
Transition to adult diabetes care is a high-risk period for acute complications, yet the optimal transition care model is unknown. To gain insight into the impact on health outcomes of system-level transition processes that reflect resourcing differences, we examined acute complications in youth with diabetes across transition in 2 Canadian provinces with different transition care models.
METHODS
We used linked provincial health administrative data for Ontario and Newfoundland and Labrador to create 2 parallel cohorts of youth with diabetes diagnosed before age 15 years who turned 17 between 2006 and 2011. Participants were followed until 2015 (maximum age 21 yr). We described rates of and proportion of participants with at least 1 diabetes-related hospital admission at age 15-17 years and 18-20 years, standardized according to material deprivation based on the 2006 Canadian Marginalization Index. We compared diabetes-related admissions at age 15-17 years and 18-20 years in the Ontario cohort.
RESULTS
The cohorts consisted of 2525 youth in Ontario and 93 in Newfoundland and Labrador. In Newfoundland and Labrador, 39 participants (42.0%) were in the lowest socioeconomic quintile, versus 326 (12.9%) in Ontario. The standardized rate of diabetes-related hospital admissions per 100 person-years was 13.5 (95% confidence interval [CI] 12.6-14.4) at age 15-17 years and 14.4 (95% CI 13.5-15.3) at age 18-20 years in Ontario, and 11.4 (95% CI 7.0-15.8) at age 15-17 years and 10.5 (95% CI 6.4-14.6) at age 18-20 years in Newfoundland and Labrador. In Ontario, there was no association between the rate (adjusted rate ratio 1.10, 95% CI 0.94-1.28) or occurrence (adjusted odds ratio 1.03, 95% CI 0.91-1.17) of diabetes-related admissions across transition.
INTERPRETATION
Although posttransition care is delivered differently in the 2 provinces, rates of adverse events across transition were stable in both. Coordinated support during transition is needed to help mitigate adverse events for young adults in both provinces. Delivery of other health care and social services, including primary care, may be influencing the risk of adverse events after transition to adult care.
背景
向成人糖尿病护理的过渡是急性并发症的高风险期，但最佳的过渡护理模式尚不清楚。为了深入了解反映资源差异的系统级过渡过程对健康结果的影响，我们研究了在 2 个具有不同过渡护理模式的加拿大省份进行过渡的青少年糖尿病患者的急性并发症。
方法
我们使用安大略省和纽芬兰和拉布拉多省的省级健康行政数据，创建了 2 个平行队列，这些队列中的参与者均在 2006 年至 2011 年期间年满 15 岁之前被诊断患有糖尿病，且在 2006 年至 2011 年期间年满 17 岁。参与者一直随访至 2015 年（最大年龄 21 岁）。我们根据 2006 年加拿大边际指数，根据物质匮乏情况对参与者在 15-17 岁和 18-20 岁时至少发生 1 次糖尿病相关住院治疗的比例和比例进行了描述。我们比较了安大略省队列中 15-17 岁和 18-20 岁之间的糖尿病相关住院治疗情况。
结果
队列包括安大略省的 2525 名参与者和纽芬兰和拉布拉多省的 93 名参与者。在纽芬兰和拉布拉多省，有 39 名参与者（42.0%）处于社会经济地位最低的五分位，而安大略省有 326 名参与者（12.9%）。在安大略省，100 人年中每 100 人中有 13.5 人（95%置信区间[CI]12.6-14.4）患有糖尿病相关的住院治疗，而在 18-20 岁时，14.4 人（95%CI13.5-15.3）患有糖尿病相关的住院治疗，在 15-17 岁时为 11.4 人（95%CI7.0-15.8），而在 18-20 岁时为 10.5 人（95%CI6.4-14.6）。在安大略省，过渡期间的发生率（调整后比率 1.10，95%CI0.94-1.28）或发生率（调整后优势比 1.03，95%CI0.91-1.17）均无相关性。
解释
尽管 2 个省份的过渡后护理方式不同，但过渡期间的不良事件发生率在 2 个省份均保持稳定。需要在过渡期间提供协调的支持，以帮助减轻两省年轻成年人的不良事件。其他医疗保健和社会服务的提供，包括初级保健，可能会影响向成人护理过渡后的不良事件风险。
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