Diabetes-related avoidable hospitalisations and its relationship with primary healthcare resourcing in China: A cross-sectional study from Sichuan Province

The reduction of diabetes-related avoidable hospitalisations (AHs) can be achieved via the provision of timely and effective primary healthcare (PHC), which has made diabetes AHs rate a widely adopted indicator for evaluating the performances of PHC systems. This study reported the AHs rate of diabetes and further explored its relationship with PHC resourcing in China. Hospital discharge data of the fourth quarters of 2016 and 2017 in Sichuan Province, China were used. The number of PHC doctors per 10,000 population and the proportion of PHC doctors on all doctors were used as indicators reflective of PHC resourcing. Linear regression models were used to explore the associations between PHC resourcing and AHs of diabetes. Age-standardised rates of diabetes-related AHs in Sichuan province, China were found to be 248.102 and 272.368 per 100,000 population in 2016 and 2017, respectively. A 10% increase in the number of PHC doctors per 10,000 population was associated with a reduction of 2.574 per 100,000 population in the age-standardised AHs rate of diabetes. In addition, 10% increase in the proportion of PHC doctors on all doctors was associated with a reduction of 10.839 diabetes-related AHs per 100,000 population. Based on subgroup analysis, PHC resourcing demonstrated to have a stronger impact on AHs of diabetes with long-term complications than on that of uncontrolled diabetes. Our findings reported that the diabetes AHs rates in Sichuan Province were prevalently high. We also found that increased PHC resourcing was associated with decreased diabetes-related AHs rates.