title: Use of health care services among diabetic Spanish adults: related factors and trends, 1993-2006.
abstract: OBJECTIVE
  We examined time trends in the use of health care services between diabetic and nondiabetic adults in Spain and their associations with sociodemographics variables.
  
  
  METHODS
  Using data from two national health surveys, we estimated use of health care services, including hospital days per person-year, in the diabetic and nondiabetic populations in 1993 (n=20,880) and 2006 (n=29,478) in Spain. As the dependent variable, we took the answer to the questions, "Has used emergency medical services in the preceding year?" and/or "Have you been admitted to hospital in the preceding year?" Independent variables were age group, gender, educational level, and coexistence of chronic conditions.
  
  
  RESULTS
  Use of emergency medical services has been significantly incremented between 1993 and 2006-from 19.6% to 36.6% for the diabetic population and from 13.8% to 29.0% for the nondiabetics. In the diabetic population, with respect to hospital admission, 13.2% of diabetics said that they had been hospitalized in 1993 compared with 18.0% in 2006 (P<.05). The results of multivariate analysis, after controlling for confounders, indicated that diabetics used significantly more health care resources in 2006 than in 1993 [odds ratio (OR)=1.34, 95% confidential interval (CI)=1.01-1.79 for admission in hospital and OR=2.03 95% CI=1.58-2.62]. Also, the length of hospital stay for diabetics increased significantly in 2006 with respect to 1993 (1.38 relative hospital days).
  
  
  CONCLUSIONS
  Spanish diabetic individuals used health care services (emergency room, admission to hospital) more often than nondiabetics. Furthermore, the length of hospital stay increased among the diabetics surveyed in 2006 compared with that in 1993.
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda de Atenas s/n, Alcorcón 28922 Madrid, Spain. ana.lopez@urjc.es <ana.lopez@urjc.es>
authors.forename: Ana
authors.initials: A
authors.lastname: Lopez-de-Andres
authors.forename: Valentín
authors.initials: V
authors.lastname: Hernández-Barrera
authors.forename: Pilar
authors.initials: P
authors.lastname: Carrasco-Garrido
authors.forename: Angel
authors.initials: A
authors.lastname: Gil-de-Miguel
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jiménez-García
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000706:statistics & numerical data* / Q000639:trends*; D048909:Diabetes Complications / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D013030:Spain / Q000453:epidemiology; D055815:Young Adult