title: Age modification of diabetes-related hospitalization among First Nations adults in Alberta, Canada.
abstract: BACKGROUND
  We sought to determine the modifying effects of age and multimorbidity on the association between First Nations status and hospitalizations for diabetes-specific ambulatory care sensitive conditions (ACSC).
  
  
  RESULTS
  We identified 183,654 adults with diabetes from Alberta Canada, and followed them for one year for the outcome of hospitalization or emergency department (ED) visit for a diabetes-specific ACSC. We used logistic regression to determine the association between First Nations status and the outcome, assessing for effect modification by age and multimorbidity with interaction terms. In a model adjusting for age, age(2), baseline A1c, duration of diabetes, and multimorbidity, First Nations people were at greater risk than non-First Nations to experience a diabetes-specific hospitalization or ED visit (unadjusted odds ratio [OR] 3.74; 95% confidence interval [CI]: 3.45-4.07). After adjustment for relevant covariates, this association varied by age (interaction: p = 0.018): adjusted OR 3.94 (95% CI: 3.11-4.99) and 5.74 (95% CI: 3.36-9.80) for First Nations compared to non-First Nations at ages 30 and 80 years, respectively.
  
  
  CONCLUSIONS
  Compared with non-First Nations, older First Nations patients with diabetes are at greater risk for diabetes-specific hospitalizations. Older First Nations patients with diabetes should be given priority access to primary care services as they are at greatest risk for requiring hospitalization for stabilization of their condition.
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, AB Canada ; Department of Medicine, University of Calgary, Calgary, AB Canada ; Interdisciplinary Chronic Disease Collaboration, Calgary, AB Canada.
authors.forename: David Jt
authors.initials: DJ
authors.lastname: Campbell
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, AB Canada.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Lacny
authors.affiliation: Department of Medicine, University of Calgary, Calgary, AB Canada ; Interdisciplinary Chronic Disease Collaboration, Calgary, AB Canada.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Weaver
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, AB Canada ; Department of Medicine, University of Calgary, Calgary, AB Canada ; Interdisciplinary Chronic Disease Collaboration, Calgary, AB Canada ; Institute of Public Health, University of Calgary, Calgary, AB Canada ; Libin Cardiovascular Institute, University of Calgary, Calgary, AB Canada.
authors.forename: Braden J
authors.initials: BJ
authors.lastname: Manns
authors.affiliation: Interdisciplinary Chronic Disease Collaboration, Calgary, AB Canada ; Libin Cardiovascular Institute, University of Calgary, Calgary, AB Canada ; Department of Medicine, University of Alberta, Edmonton, AB Canada.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, AB Canada ; Department of Medicine, University of Calgary, Calgary, AB Canada ; Institute of Public Health, University of Calgary, Calgary, AB Canada.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Barnabe
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, AB Canada ; Department of Medicine, University of Calgary, Calgary, AB Canada ; Interdisciplinary Chronic Disease Collaboration, Calgary, AB Canada ; Institute of Public Health, University of Calgary, Calgary, AB Canada ; Libin Cardiovascular Institute, University of Calgary, Calgary, AB Canada ; Foothills Medical Centre, Room C210, 3330 Hospital Dr. NW, Calgary, AB T2N 1N4 Canada.
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
keywords: American indian; Diabetes mellitus; First Nations; Hospitalization; Risk adjustment