Background
Methods
Design
Patient linkage
Study population
Measures
Statistical analyses
DM only | DM + any comorbidity (n = 3,324) | Type of comorbidity | ||||||
---|---|---|---|---|---|---|---|---|
DM + only dm-related comorbidity | DM + only non dm-related comorbidity | DM + both types of comorbidity | ||||||
Number of comorbidities
|
-
|
1
|
2
|
≥3
| ||||
(n = 4,175)
|
(n = 2,419)
|
(n = 718)
|
(n = 187)
|
(n = 871)
|
(n = 1,856)
|
(n = 597)
| ||
%/Mean (SD) | %/Mean (SD) | %/Mean (SD) | %/Mean (SD) | %/Mean (SD) | %/Mean (SD) | %/Mean (SD) | P-value | |
Percentage of total (%) | 55.7 | 32.3 | 9.6 | 2.5 | 11.6 | 24.7 | 8.0 | |
Patient characteristics
| ||||||||
Sex (% male) | 48.4 | 43.7 | 40.4 | 41.2 | 51.2 | 39.0 | 42.5 | 0.000 |
Mean age (in years) | 62.6 | 66.9 | 71.1 | 72.9 | 71.5 | 64.9 | 73.1 | 0.000 |
Educational level (%) # | ||||||||
Low | 43.2 | 49.8 | 55.6 | 59.4 | 56.1 | 47.3 | 58.3 | 0.000 |
Middle | 46.3 | 42.7 | 40.8 | 35.3 | 37.3 | 45.4 | 37.7 | |
High | 10.5 | 7.4 | 3.6 | 5.3 | 6.5 | 7.3 | 4.0 | |
Mean number of comorbidities | 1.11 | 1.13 | 2.34 | 0.000 | ||||
Medical health care utilization
| ||||||||
GP care
| ||||||||
% of patients with GP contacts | 100 | 100 | 100 | 100 | 100 | 100 | 100 | |
Number of contacts with GP (per year) | 8.9 (6.5) | 13.7 (8.60) | 20.8 (12.8) | 28.8 (15.9) | 15.0 (10.6) | 14.3 (9.1) | 23.2 (14.0) | 0.000 |
% of patients with prescriptions | 97.0 | 98.5 | 99.3 | 98.4 | 99.4 | 98.2 | 99.2 | 0.000 |
Number of prescriptions (per year) | 18.1(16.8) | 25.9 (21.0) | 39.8 (31.3) | 57.1 (44.2) | 32.0 (25.3) | 25.6 (23.0) | 44.4 (33.9) | 0.000 |
Ambulatory medical specialist care† | ||||||||
% of patients with consultations | 12.3 | 23.0 | 30.4 | 38.0 | 17.8 | 26.5 | 33.3 | 0.000 |
Number of consultations (per year) | 2.1 (1.4) | 2.7 (1.7) | 3.4 (2.0) | 4.0 (2.3) | 2.7 (1.6) | 2.8 (1.8) | 3.6 (2.2) | 0.000 |
Hospital care
| ||||||||
% of patients with hospital admission† | 5.1 | 14.7 | 23.1 | 31.0 | 13.8 | 16.2 | 26.5 | 0.000 |
Number of hospital admissions (per year) | 1.7 (1.3) | 2.3 (2.1) | 2.9 (2.8) | 3.2 (2.3) | 2.7 (2.3) | 2.3 (2.3) | 2.9 (2.5) | 0.000 |
Average length of stay (per admission) | 6.7 (10.6) | 6.3 (7.7) | 8.0 (7.5) | 11.2 (11.4) | 7.9 (7.8) | 5.8 (7.6) | 9.5 (9.1) | 0.001 |
Total hospital days (per year) | 10.7 (16.3) | 14.8 (21.0) | 22.4 (26.5) | 31.9 (27.3) | 21.1 (24.4) | 14.2 (22.1) | 25.3 (25.6) | 0.000 |
DM + any comorbidity (n = 3,324) | Type of comorbidity | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
DM + only dm-related comorbidity | DM + only non dm-related comorbidity | DM + both types of comorbidity | ||||||||||
Number of comorbidities | 1 (n = 2,419) | 2 (n = 718) | ≥3 (n = 187) | (n = 871) | (n = 1,856) | (n = 597) | ||||||
β/OR | CI 95% | β/OR | CI 95% | β/OR | CI 95% | β/OR | CI 95% | β/OR | CI 95% | β/OR | CI 95% | |
GP care
| ||||||||||||
No. of visits to GP (β) | 3.9 | (3.6, 4.3) | 10.3 | (9.7, 10.9) | 18.0 | (16.9, 19.1) | 4.6 | (4.1, 5.2) | 4.7 | (4.2, 5.1) | 12.4 | (11.7, 13.0) |
% patients with prescriptions (OR) | * | * | * | * | * | * | ||||||
No. of prescriptions (β) | 6.9 | (5.9, 7.9) | 19.2 | (17.6, 20.8) | 35.9 | (33.0, 38.7) | 11.7 | (10.3, 13.2) | 7.0 | (5.9, 8.0) | 23.4 | (21.7, 25.2) |
Ambulatory medical specialist care† | ||||||||||||
% of patients with consultations (OR) | 2.4 | (2.1, 2.8) | 3.7 | (3.1, 4.6) | 5.6 | (4.0, 7.9) | 1.7 | (1.4, 2.1) | 2.9 | (2.5, 3.3) | 4.3 | (3.5, 5.4) |
No. of consultations (β) | 0.4 | (0.3, 0.4) | 0.8 | (0.7,0.9) | 1.3 | (1.1, 1.5) | 0.2 | (0.1, 0.3) | 0.5 | (0.4, 0.6) | 1.0 | (0.8, 1.1) |
Hospital care
| ||||||||||||
% patients with hospital admission (OR) | 3.4 | (2.9, 4.2) | 6.4 | (5.1, 8.2) | 9.8 | (6.8, 14.0) | 3.3 | (2.5, 4.2) | 3.8 | (3.2, 4.6) | 7.7 | (6.0, 9.9) |
No. of hospital admissions (β) | 0.3 | (0.2, 0.3) | 0.6 | (0.5, 0.7) | 0.9 | (0.8, 1.1) | 0.3 | (0.2, 0.4) | 0.3 | (0.2, 0.4) | 0.7 | (0.6, 0.8) |
Average length of stay (β) | 0.6 | (0.4, 0.7) | 1.4 | (1.1, 1.7) | 3.0 | (2.5, 3.6) | 0.7 | (0.4, 0.9) | 0.6 | (0.4, 0.9) | 2.1 | (1.8, 2.4) |
Total hospital days (β) | 1.5 | (1.1, 2.0) | 4.5 | (3.7, 5.2) | 9.1 | (7.8, 10.4) | 2.2 | (1.5, 2.8) | 1.7 | (1.2, 2.2) | 5.9 | (5.1, 6.7) |
DM-related comorbidity | Heart diseases (n = 1,096) | Stroke (n = 218) | Retinopathy (n = 63) | Nephropathy (n = 57) | Diabetic Foot (n = 204) | |||||
---|---|---|---|---|---|---|---|---|---|---|
β/OR | CI 95% | β/OR | CI 95% | β/OR | CI 95% | β/OR | CI 95% | β/OR | CI 95% | |
GP care
| ||||||||||
No. of visits to GP (β) | 5.2 | (4.74, 5.73) | 3.4 | (2.4, 4.4) | 3.20 | (1.37, 5.04) | 5.6 | (3.7, 7.6) | 8.46 | (7.42, 9.48) |
% patients with prescriptions (OR) | * | * | * | * | * | |||||
No. of prescriptions (β) | 12.8 | (11.52, 14.1) | 4.1 | (1.6, 6.7) | 5.62 | (0.90, 10.36) | 12.1 | (7.2, 17.0) | 20.88 | (18.23, 23.54) |
Ambulatory medical specialist care† | ||||||||||
% of patients with consultations (OR) | 1.7 | (1.5, 2.1) | 2.0 | (1.5, 2.9) | 1.4 | (0.8, 2.7) | 1.0 | (0.5, 1.9) | 1.0 | (0.7, 1.5) |
No. of consultations (β) | 0.4 | (0.3, 0.4) | 0.4 | (0.2, 0.6) | -0.2 | (-0.1, 0.5) | -0.1 | (-0.5, 0.2) | 0.0 | (-0.2, 0.2) |
Hospital care
| ||||||||||
% patients with admission (OR) | 2.6 | (2.2, 3.2) | 2.8 | (2.0, 4.1) | 1.9 | (1.00, 3.7) | 0.9 | (0.4, 1.9) | 1.4 | (0.9, 2.1) |
No. of hospital admissions (β) | 0.4 | (0.3, 0.4) | 0.4 | (0.2, 0.5) | 0.3 | (0.1, 0.6) | 0.2 | (-0.1, 0.4) | 0.1 | (-0.0, 0.2) |
Average length of stay (β) | 0.9 | (0.7, 1.1) | 1.5 | (1.0, 2.0) | 0.7 | (-0.2, 1.6) | -0.2 | (-1.1,0.7) | 0.8 | (0.3, 1.3) |
Total hospital days (β) | 3.1 | (2.5, 3.7) | 3.3 | (2.1, 4.4) | 2.1 | (0.0, 4.3) | 0.8 | (-1.5, 3.1) | 2.4 | (1.2, 3.6) |
Non DM-related comorbidity
|
Depression (n = 295)
|
Neurological diseases (n = 69)
|
Musculoskeletal Diseases (n = 1,722)
|
Lung Diseases (n = 531)
|
Cancer (n = 206)
| |||||
β/OR | CI 95% | β/OR | CI 95% | β/OR | CI 95% | β/OR | CI 95% | β/OR | CI 95% | |
GP care
| ||||||||||
No. of visits to GP (β) | 6.8 | (5.9, 7.6) | 4.1 | (2.4, 5.9) | 4.1 | (3.7, 4.5) | 5.3 | (4.6, 5.9) | 5.9 | (4.9, 6.9) |
% patients with prescriptions (OR) | * | * | * | * | * | |||||
No. of prescriptions (β) | 12.9 | (10.6, 15.1) | 8.0 | (3.5, 12.5) | 4.2 | (3.2, 5.3) | 15.3 | (13.6, 17.0) | 3.4 | (0.8, 6.1) |
Ambulatory medical specialist care† | ||||||||||
% of patients with consultations (OR) | 1.1 | (0.8, 1.5) | 1.0 | (0.5, 1.8) | 3.6 | (3.1, 4.1) | 1.2 | (1.0, 1.5) | 1.3 | (0.9, 1.9) |
No. of consultation by specialist (β) | 0.2 | (0.1, 0.3) | 0.1 | (-0.2, 0.3) | 0.6 | (0.6, 0.7) | 0.3 | (0.2, 0.4) | 0.4 | (0.2, 0.5) |
Hospital care
| ||||||||||
% patients with admission (OR) | 1.3 | (0.9, 1.9) | 1.5 | (0.8, 2.9) | 3.8 | (3.2, 4.4) | 1.2 | (0.9, 1.6) | 1.8 | (1.2, 2.7) |
No. of hospital admissions (β) | 0.1 | (0.0, 0.2) | 0.0 | (-0.3, 0.2) | 0.3 | (0.3, 0.4) | 0.1 | (0.1, 0.2) | 0.4 | (0.2, 0.5) |
Average length of stay (β) | 0.5 | (0.1, 0.9) | 0.5 | (-0.3, 1.4) | 0.9 | (0.7, 1.1) | 0.4 | (0.0, 0.7) | 0.5 | (0.0,1.0) |
Total hospital days (β) | 1.5 | (0.5, 2.6) | 0.1 | (-1.9, 2.2) | 2.3 | (1.8, 2.7) | 1.47 | (0.7, 2.2) | 2.4 | (1.2, 3.6) |