Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Folkhälsan Research Centre, Helsinki, Finland.
Scand J Prim Health Care. 2023 Dec;41(4):392-399. doi: 10.1080/02813432.2023.2255062. Epub 2023 Sep 14.
This study aimed to examine primary health care (PHC) service utilization and mortality in older patients with type 2 diabetes (T2D) with or without comorbidities.
A cohort study in PHC in the city of Vantaa, Finland. Follow-up period was set between the years 2011 and 2018.
PHC patients aged 60 years or more with a T2D were included.
Service utilization was defined as the number of face-to-face appointments and telephone contacts between a patient and general practitioner (GP) or nurse. The presence of comorbidities was defined using the Charlson Comorbidity Index (CCI). Mortality was assessed using hazard ratio (HR) and standardized mortality ratio (SMR).
In total, 11,020 patients were included and followed for 71,596 person years. Mean age of the women and men in the beginning of follow-up were 71 and 69 years, respectively. The patients in the study cohort had a mean of eight appointments per person year to the GPs or nurses. Patients with T2D with comorbidities had more appointments than patients with T2D without comorbidities (incidence rate ratio (IRR) 1.44 [95% CI 1.39-1.49]). Increase in the number of all appointments reduced mortality in patients with T2D with and without comorbidities. Between patients with T2D with comorbidities and patients with T2D without comorbidities, the age and sex adjusted HR for death was 1.50 (95% CI 1.39-1.62). The SMR was higher in patients with T2D with comorbidities (1.83 [95% CI 1.74-1.92]) than in patients with T2D without comorbidities (0.91 [95% CI 0.86-0.96]).
In older patients with T2D, the presence of comorbidities was associated with increased use of PHC services and increased mortality. Increase in the number of appointments was associated with reduced mortality in patients with T2D with or without comorbidities.Key PointsIn older patients with T2D, it has not been studied whether and to what extend multimorbidity affects use of PHC services and mortality.The presence of comorbidities according to the Charlson Comorbidity Index (CCI) was associated with increased use of PHC services.The number of appointments to GPs or nurses was associated with reduced mortality in patients with T2D with or without comorbidities according to the CCI.
本研究旨在探讨伴有或不伴有合并症的 2 型糖尿病（T2D）老年患者的初级保健（PHC）服务利用情况和死亡率。
这是一项在芬兰万塔市 PHC 进行的队列研究。随访时间设定在 2011 年至 2018 年之间。
纳入年龄在 60 岁及以上且患有 T2D 的 PHC 患者。
服务利用情况定义为患者与全科医生（GP）或护士之间的面对面预约和电话联系次数。合并症的存在使用 Charlson 合并症指数（CCI）来定义。死亡率使用风险比（HR）和标准化死亡率比（SMR）进行评估。
共纳入 11020 名患者，随访 71596 人年。女性和男性在随访开始时的平均年龄分别为 71 岁和 69 岁。研究队列中的患者每人每年平均接受 8 次 GP 或护士的预约。患有合并症的 T2D 患者比没有合并症的 T2D 患者接受的预约更多（发病率比（IRR）1.44 [95%CI 1.39-1.49]）。所有预约次数的增加均降低了伴有和不伴有合并症的 T2D 患者的死亡率。患有合并症的 T2D 患者与没有合并症的 T2D 患者相比，死亡的年龄和性别调整 HR 为 1.50（95%CI 1.39-1.62）。患有合并症的 T2D 患者的 SMR 更高（1.83 [95%CI 1.74-1.92]），而没有合并症的 T2D 患者的 SMR 较低（0.91 [95%CI 0.86-0.96]）。
在患有 T2D 的老年患者中，合并症的存在与 PHC 服务利用的增加和死亡率的增加有关。增加预约次数与伴有或不伴有合并症的 T2D 患者的死亡率降低有关。
在患有 T2D 的老年患者中，尚未研究合并症的存在及其对 PHC 服务利用和死亡率的影响程度。根据 Charlson 合并症指数（CCI），合并症的存在与 PHC 服务的利用增加有关。根据 CCI，GP 或护士的预约次数与伴有或不伴有 CCI 的 T2D 患者的死亡率降低有关。
