Hospitalization risk in a type 2 diabetes cohort.
BACKGROUND
Using a health outcome research framework, the hospitalization risk for a type 2 diabetes (T2DM) cohort is evaluated. Diabetes is "ambulatory care sensitive"--a condition largely manageable with appropriate care in the community. Thus, hospitalization may represent a negative care outcome.


METHODS
Analyses were conducted by linking data from the Canadian Community Health Survey (CCHS) cycle 1.1 to the Canadian Hospital Morbidity Database for respondents identified as having T2DM. Logistic regression was used to examine the association between the likelihood of all-cause hospitalization within two years of the survey date and patients' characteristics, care path, and health system characteristics.


RESULTS
When the effects of demographic, socio-economic and health status characteristics were taken into account, physical inactivity and former or current smoking were significantly associated with an increased likelihood of hospitalization for those with type 2 diabetes. Specialist visits were positively related to hospitalization (OR = 1.4), whereas the relationship with general practitioner visits was negative (OR = 0.7). Regional hospital use patterns were significantly associated with hospitalization (OR = 2.6).


CONCLUSIONS
Regional patterns of hospital use are important for hospitalization: T2DM residents of health regions with generally higher hospitalization rates were more likely to be hospitalized than were those living elsewhere. In terms of care path, GP consultations were associated with a lower risk of hospitalization. Specialist consultations, likely a marker of disease severity, had the reverse effect.
Ng
Edward
E
Health Analysis Division, Statistitics Canada, Ottawa, Ontario, K1A OT6. edward.ng@statcan.gc.ca
McGrail
Kimberlyn M
KM
Johnson
Jeffrey A
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada; D002648:Child; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2; D015444:Exercise; D005194:Family Practice; D005260:Female; D019538:Health Care Surveys; D006302:Health Services Research; D006304:Health Status; D006753:Hospital Records; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008511:Medicine; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D012907:Smoking; D016540:Smoking Cessation