Department of Family Medican and Primary Care, University of Hong Kong, Hong Kong, China.
Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
Sci Rep. 2022 Feb 2;12(1):1794. doi: 10.1038/s41598-022-05557-5.
Diabetes is an ambulatory care sensitive condition that quality of care can prevent complications development and hospitalization needs. However, diabetes patients with disability face greater challenges with receiving quality diabetes care than those without disabilities. This study examined diabetes-related avoidable hospitalizations (DRAH) focusing on the association with disability. We used nationally representative health insurance cohort data from 2002 to 2013. The study population is people who were newly diagnosed with type 2 diabetes. We measured the cumulated number of DRAH using the Prevention Quality Indicators (PQIs). The variables of interest were disability severity and type. We performed a recurrent events analysis using Cox proportional hazard regression model. Among 49,410 type 2 diabetes patients, 12,231 (24.8%) experienced DRAHs at least once during the follow-up period. Among the total population, 5924 (12.0%) diabetes patients were registered as disabled. The findings report that disability severity was significantly associated with higher risks for DRAH, where severely disabled diabetes patients showed the highest hazard ratio of 2.24 (95% CI 1.80-2.79). Among three DRAH indicators, severely disabled diabetes patients showed increased risks for long-term (AHR 2.21, 95% CI 1.89-2.60) and uncontrolled (AHR 2.28, 95% CI 1.80-2.88) DRAH. In addition, intellectual (AHR 5.52, 95% CI 3.78-8.05) and mental (AHR 3.97, 95% CI 2.29-6.89) disability showed higher risks than other types of disability. In conclusion, diabetes patients with disability are at higher risk for DRAH compared to those without disabilities, and those with intellectual and mental disabilities were more likely to experience DRAH compared to those with physical or other types of disability. These findings call for action to find the more appropriate interventions to improve targeted diabetes primary care for patients with disability. Further research is needed to better understand determinants of increasing risks of DRAH.
糖尿病是一种需要门诊护理的敏感疾病，护理质量可以预防并发症的发生和住院需求。然而，患有残疾的糖尿病患者在接受高质量的糖尿病护理方面面临着比没有残疾的患者更大的挑战。本研究重点关注残疾与糖尿病相关的可避免住院治疗（DRAH）的关系。我们使用了 2002 年至 2013 年全国代表性的健康保险队列数据。研究人群是新诊断为 2 型糖尿病的患者。我们使用预防质量指标（PQIs）来衡量累积的 DRAH 数量。感兴趣的变量是残疾的严重程度和类型。我们使用 Cox 比例风险回归模型进行了复发性事件分析。在 49410 名 2 型糖尿病患者中，有 12231 名（24.8%）在随访期间至少经历过一次 DRAH。在总人群中，有 5924 名（12.0%）糖尿病患者被登记为残疾。研究结果报告称，残疾的严重程度与 DRAH 的发生风险显著相关，其中严重残疾的糖尿病患者的风险比最高，为 2.24（95%CI 1.80-2.79）。在三个 DRAH 指标中，严重残疾的糖尿病患者发生长期（AHR 2.21，95%CI 1.89-2.60）和控制不良（AHR 2.28，95%CI 1.80-2.88）DRAH 的风险增加。此外，智力（AHR 5.52，95%CI 3.78-8.05）和精神（AHR 3.97，95%CI 2.29-6.89）残疾比其他类型的残疾风险更高。总之，与无残疾的糖尿病患者相比，有残疾的糖尿病患者发生 DRAH 的风险更高，而智力和精神残疾的患者比身体残疾或其他类型残疾的患者更有可能发生 DRAH。这些发现呼吁采取行动，寻找更合适的干预措施，以改善针对残疾患者的有针对性的糖尿病初级保健。需要进一步研究以更好地了解增加 DRAH 风险的决定因素。
