Comorbidity and its relationship with health service use and cost in community-living older adults with diabetes: A population-based study in Ontario, Canada

被引:43
|
作者
Fisher, Kathryn [1 ]
Griffith, Lauren [2 ]
Gruneir, Andrea [3 ]
Panjwani, Dilzayn [4 ]
Gandhi, Sima [5 ]
Sheng, Li [5 ]
Gafni, Amiram [6 ]
Chris, Patterson [7 ]
Markle-Reid, Maureen [8 ]
Ploeg, Jenny [8 ]
机构
[1] McMaster Univ, Sch Nursing, 1280 Main St West,Hlth Sci Ctr Room, Hamilton, ON L8S 4K1, Canada
[2] McMaster Univ, Dept Clin Epidemiol & Biostat, McMaster Innovat Pk,175 Longwood Rd South, Hamilton, ON L8P 0A1, Canada
[3] 6 40 Univ Alberta, Dept Family Med, 6-10 Univ Terrace, Edmonton, AB T6G 2T4, Canada
[4] Womens Coll Hosp, Womens Coll Res Inst, 790 Bay St,7th Floor, Toronto, ON M5G 1N8, Canada
[5] ICES, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
[6] McMaster Univ, Ctr Hlth Econ & Policy Anal, Dept Clin Epidemiol & Biostat, 1280 Main St West,Room CRL 208, Hamilton, ON L8S 4K1, Canada
[7] McMaster Univ, Dept Med, Hlth Sci Ctr, 1280 Main St West,Room 3N25B, Hamilton, ON L8S 4K, Canada
[8] McMaster Univ, Sch Nursing, 1280 Main St West,Hlth Sci Ctr Room, Hamilton, ON L8S 4K1, Canada
基金
加拿大健康研究院;
关键词
Diabetes; Community-living older adults; Health service utilization; Health service costs; Comorbidity; Multimorbidity; TERM-CARE RESIDENTS; HOSPITALIZATION COSTS; MELLITUS; PREVALENCE; IMPACT; MULTIMORBIDITY; COMPLICATIONS; QUALITY; BURDEN; RISK;
D O I
10.1016/j.diabres.2016.10.009
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims: This study describes the comorbid conditions in Canadian, community-dwelling older adults with diabetes and the association between the number of comorbidities and health service use and costs. Methods: This retrospective cohort study used multiple linked administrative data to determine 5-year health service utilization in a population-based cohort of community-living individuals aged 66 and over with a diabetes diagnosis as of April 1, 2008 (baseline). Utilization included physician visits, emergency department visits, hospitalizations, and home care services. Results: There were 376,421 cohort members at baseline, almost all (95%) of which had at least one comorbidity and half (46%) had 3 or more. The most common comorbidities were hypertension (83%) and arthritis (61%). Service use and associated costs consistently increased as the number of comorbidities increased across all services and follow-up years. Conditions generally regarded as nondiabetes-related were the main driver of service use. Over time, use of most services declined for people with the highest level of comorbidity (3+). Hospitalizations and emergency department visits represented the largest share of costs for those with the highest level of comorbidity (3+), whereas physician visits were the main costs for those with fewer comorbidities. Conclusions: Comorbidities in community-living older adults with diabetes are common and associated with a high level of health service use and costs. Accordingly, it is important to use a multiple chronic conditions (not single-disease) framework to develop coordinated, comprehensive and patient-centred programs for older adults with diabetes so that all their needs are incorporated into care planning. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:113 / 123
页数:11
相关论文
共 50 条
  • [31] Potential diabetes overtreatment and risk of adverse events among older adults in Ontario: a population-based study
    Lega, Iliana C.
    Campitelli, Michael A.
    Austin, Peter C.
    Na, Yingbo
    Zahedi, Afshan
    Leung, Freda
    Yu, Catherine
    Bronskill, Susan E.
    Rochon, Paula A.
    Lipscombe, Lorraine L.
    DIABETOLOGIA, 2021, 64 (05) : 1093 - 1102
  • [32] Current Use of Domperidone and Co-prescribing of Medications that Increase Its Arrhythmogenic Potential Among Older Adults: A Population-Based Cohort Study in Ontario, Canada
    Rojas-Fernandez, Carlos
    Stephenson, Anne L.
    Fischer, Hadas D.
    Wang, Xuesong
    Mestre, Tiago
    Hutson, Janine R.
    Pondal, Margarita
    Lee, Douglas S.
    Rochon, Paula A.
    Marras, Connie
    DRUGS & AGING, 2014, 31 (11) : 805 - 813
  • [33] Current Use of Domperidone and Co-prescribing of Medications that Increase Its Arrhythmogenic Potential Among Older Adults: A Population-Based Cohort Study in Ontario, Canada
    Carlos Rojas-Fernandez
    Anne L. Stephenson
    Hadas D. Fischer
    Xuesong Wang
    Tiago Mestre
    Janine R. Hutson
    Margarita Pondal
    Douglas S. Lee
    Paula A. Rochon
    Connie Marras
    Drugs & Aging, 2014, 31 : 805 - 813
  • [34] Integrated and Person-Centered Care for Community-Living Older Adults: A Cost-Effectiveness Study
    Uittenbroek, Ronald J.
    van Asselt, Antoinette D. I.
    Spoorenberg, Sophie L. W.
    Kremer, Hubertus P. H.
    Wynia, Klaske
    Reijneveld, Sijmen A.
    HEALTH SERVICES RESEARCH, 2018, 53 (05) : 3471 - 3494
  • [35] Formal and informal care of community-living older people: A population-based study from the Swedish National study on Aging and Care
    Anders Wimo
    S. Elmståhl
    L. Fratiglioni
    B. -M. Sjölund
    A. Sköldunger
    C. Fagerström
    J. Berglund
    M. Lagergren
    The journal of nutrition, health & aging, 2017, 21 : 17 - 24
  • [36] FORMAL AND INFORMAL CARE OF COMMUNITY-LIVING OLDER PEOPLE: A POPULATION-BASED STUDY FROM THE SWEDISH NATIONAL STUDY ON AGING AND CARE
    Wimo, A.
    Elmstahl, S.
    Fratiglioni, L.
    Sjlolund, B. -M.
    Skoldunger, A.
    Fagerstrom, C.
    Berglund, J.
    Lagergren, M.
    JOURNAL OF NUTRITION HEALTH & AGING, 2017, 21 (01): : 17 - 24
  • [37] Factors associated with loneliness in immigrant and Canadian-born older adults in Ontario, Canada: a population-based study
    Lu, Mindy
    Bronskill, Susan E.
    Strauss, Rachel
    Boblitz, Alexa
    Guan, Jun
    Im, James H. B.
    Rochon, Paula A.
    Gruneir, Andrea
    Savage, Rachel D.
    BMC GERIATRICS, 2023, 23 (01)
  • [38] Adherence to Serum Urate Monitoring Guidelines Among Older Adults With Gout in Ontario, Canada: A Population-Based Study
    Kwok, Timothy
    Kuriya, Bindee
    Hawker, Gillian
    Li, Ping
    Choy, Gregory
    Widdifield, Jessica
    JOURNAL OF RHEUMATOLOGY, 2023, 50 (07) : 9 - 9
  • [39] Factors associated with loneliness in immigrant and Canadian-born older adults in Ontario, Canada: a population-based study
    Mindy Lu
    Susan E. Bronskill
    Rachel Strauss
    Alexa Boblitz
    Jun Guan
    James H.B. Im
    Paula A. Rochon
    Andrea Gruneir
    Rachel D. Savage
    BMC Geriatrics, 23
  • [40] Marijuana use among community-dwelling older adults: A population-based study
    De Genna, Natacha M.
    Jacobsen, Erin
    Ganguli, Mary
    INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, 2024, 39 (04)