title: Comorbidity Burden and Health Services Use in Community-Living Older Adults with Diabetes Mellitus: A Retrospective Cohort Study.
abstract: OBJECTIVE
  Diabetes frequently coexists with other conditions, resulting in poorer diabetes self-management and quality of life, higher risk for diabetes-related complications and higher health service use compared to those with diabetes only. Few Canadian studies have undertaken a comprehensive, population-level analysis of comorbidity and health service utilization by older adults with diabetes. This study examined comorbidity and its association with a broad range of health services in a cohort of community-dwelling older adults with diabetes in Ontario, Canada.
  
  
  METHODS
  We linked multiple administrative databases to create a cohort of 448,736 older adults with diabetes, described their comorbidities and obtained their 1-year use of health services (physician visits, emergency department visits, inpatient hospital admissions, home care use, nursing home admissions). We examined comorbidity patterns by age and gender and estimated the prevalence of 20 comorbid conditions and the most common condition clusters. The association between number of comorbidities and health service use was also examined.
  
  
  RESULTS
  More than 90% of the cohort had at least 1 comorbid condition. The number of comorbidities increased with age for both genders, and hypertension was the most common, affecting 79.1% of the cohort. Other common conditions included other cardiovascular conditions, ischemic heart disease, arthritis and anxiety. Utilization of all health services increased with the number of comorbid conditions.
  
  
  CONCLUSIONS
  Health service use was driven by the number of comorbid conditions, including diabetes and nondiabetes-related conditions, highlighting the importance of aligning diabetes care plans with patients' comorbidities.
authors.affiliation: Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada. Electronic address: gruneir@ualberta.ca.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
authors.affiliation: Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Maureen
authors.initials: M
authors.lastname: Markle-Reid
authors.affiliation: Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Fisher
authors.affiliation: Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Holly
authors.initials: H
authors.lastname: Reimer
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Xiaomu
authors.initials: X
authors.lastname: Ma
authors.affiliation: Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ploeg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015331:Cohort Studies; D003153:Community Health Services; D015897:Comorbidity; D017281:Cost of Illness; D048909:Diabetes Complications / Q000453:epidemiology / Q000628:therapy*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D016247:Information Storage and Retrieval; D008297:Male; D009735:Nursing Homes; D009864:Ontario / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care; D012189:Retrospective Studies
keywords: community living; comorbidity; comorbidité; diabetes; diabète, utilisation des services de santé; health service utilization; older adults; personnes âgées; vie dans la communauté