The burden of hospitalization related to diabetes mellitus: A population-based study
Introduction
The prevalence of type 1 and type 2 diabetes mellitus is quickly and alarmingly increasing worldwide, and it is progressively assuming the of a global epidemic, in both developed and developing countries [1], [2]. Based on International Diabetes Federation population projections, in Italy the prevalence of diabetes could reach 10.4% in the age range 20–79 years in 2030 [2], [3], being more than double the percentage identified in an Italian study conducted in 2003 [4]. The number of people with diagnosed diabetes could thus increase to 4 million by a few years. The burden of the disease is increasing both for the progressive aging of population and for the worsening of lifestyle [5], [6]. Along with the increase in the prevalence of the disease, a parallel, dramatic escalation of the clinical, social and economic burden of diabetes and its complications, particularly those of the cardiovascular system, is expected [7], [8]. Care of individuals with diabetes generate a consistent use of hospital resources, the greatest impact on hospital stay and expense is from hospitalizations being attributable to chronic complications, especially cardiovascular complications. The prevention of diabetes and the control of its complications therefore became one of the most important challenges of the XXI century, aimed at the substantial reduction of diabetes-related morbidity, mortality, and overall health care expenditure. Fortunately, several pharmacological and nonpharmacological interventions for the reduction of the risk of diabetes complications have been proved to be effective in randomized clinical trials and are currently available [9], [10], [11]. Nevertheless, a gap persists between recommendations and clinical practice, as recently documented by an Italian quality improvement program report [12]. The persistence of sub-optimal care can be responsible for an increased risk of complications [13], which in turns determines an increased demand for hospital care. The use of administrative databases represents an efficient instrument, complementary to ad hoc studies, for the continuous monitoring of morbidity and resource consumption related to diabetes mellitus. Diabetes presents, in fact, a feasible detection by the use of a highly specific pharmacologic treatment.
The aim of this study was to estimate in different age classes the impact of diabetes and its complications on the likelihood of hospital admission for specific causes, using a record-linkage analysis of administrative databases.
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Methods
We carried out a record-linkage analysis of hospital discharge records, prescription databases, and the civil registry, including data on 8,940,420 citizens in 21 local Health authorities (LHAs) in different Italian regions, in the last available year (2007 or 2008).
Record-linkage analysis is increasingly recognized as a reliable research tool to assess the interplay between different clinical conditions to evaluate outcomes in large, unselected populations which better represent the real
Results
The ReClust Record Linkage System allowed the identification of 498,825 diabetic patients over 8,940,420 inhabitants (prevalence of 5.6%) according to antidiabetic agents prescriptions, and of a random group of 2,494,125 patients without diabetes (1:5 ratio) balanced for age, gender, and LHAs. Pre-matching characteristics are presented in Online Appendix Table A3. The propensity score-based greedy matching algorithm successfully matched 492,146 diabetic patients. Adequacy of covariate balance
Discussion
This study provides a useful model to describe the burden of the disease in terms of diabetic complications, health services utilization, and health outcome. From prescription data, the prevalence of pharmacologically treated diabetes is estimated to be 5.6%. This is a conservative estimate, based on at least two prescriptions during the year, and does not take into account individuals with diabetes treated only with lifestyle interventions. Therefore, considering that about 10% of diabetic
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