Comorbidity and its relationship with health service use and cost in community-living older adults with diabetes: A population-based study in Ontario, Canada.
OBJECTIVE
This study describes the comorbid conditions in Canadian, community-dwelling older adults with diabetes and the association between the number of comorbidities and health service use and costs.


METHODS
This retrospective cohort study used multiple linked administrative data to determine 5-year health service utilization in a population-based cohort of community-living individuals aged 66 and over with a diabetes diagnosis as of April 1, 2008 (baseline). Utilization included physician visits, emergency department visits, hospitalizations, and home care services.


RESULTS
There were 376,421 cohort members at baseline, almost all (95%) of which had at least one comorbidity and half (46%) had 3 or more. The most common comorbidities were hypertension (83%) and arthritis (61%). Service use and associated costs consistently increased as the number of comorbidities increased across all services and follow-up years. Conditions generally regarded as nondiabetes-related were the main driver of service use. Over time, use of most services declined for people with the highest level of comorbidity (3+). Hospitalizations and emergency department visits represented the largest share of costs for those with the highest level of comorbidity (3+), whereas physician visits were the main costs for those with fewer comorbidities.


CONCLUSIONS
Comorbidities in community-living older adults with diabetes are common and associated with a high level of health service use and costs. Accordingly, it is important to use a multiple chronic conditions (not single-disease) framework to develop coordinated, comprehensive and patient-centred programs for older adults with diabetes so that all their needs are incorporated into care planning.
School of Nursing, McMaster University, 1280 Main Street West, Health Sciences Centre Room, Hamilton, Ontario L8S 4K1, Canada. Electronic address: fisheka@mcmaster.ca.
Kathryn
K
Fisher
Department of Clinical Epidemiology and Biostatistics, McMaster University, McMaster Innovation Park, 175 Longwood Road South, Hamilton, ON L8P 0A1, Canada. Electronic address: griffith@mcmaster.ca.
Lauren
L
Griffith
Department of Family Medicine, 6-40 University of Alberta, 6-10 University Terrace, Edmonton, AB T6G 2T4, Canada. Electronic address: gruneir@ualberta.ca.
Andrea
A
Gruneir
Women's College Research Institute, Women's College Hospital, 790 Bay Street, 7th Floor, Toronto, ON M5G 1N8, Canada. Electronic address: dilzayn.panjwani@wchospital.ca.
Dilzayn
D
Panjwani
Institute for Clinical Evaluative Sciences (ICES), 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. Electronic address: sima.gandhi@ices.on.ca.
Sima
S
Gandhi
Institute for Clinical Evaluative Sciences (ICES), 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. Electronic address: lisa.sheng@ices.on.ca.
Li Lisa
LL
Sheng
Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Room CRL-208, Hamilton, Ontario L8S 4K1, Canada,. Electronic address: gafni@mcmaster.ca.
Amiram
A
Gafni
Department of Medicine, McMaster University, 1280 Main Street West, Health Sciences Centre, Room 3N25B, Hamilton, Ontario L8S 4K, Canada. Electronic address: PATTEC@HHSC.CA.
Patterson
P
Chris
School of Nursing, McMaster University, 1280 Main Street West, Health Sciences Centre Room, Hamilton, Ontario L8S 4K1, Canada. Electronic address: mreid@mcmaster.ca.
Maureen
M
Markle-Reid
School of Nursing, McMaster University, 1280 Main Street West, Health Sciences Centre Room, Hamilton, Ontario L8S 4K1, Canada. Electronic address: ploegj@mcmaster.ca.
Jenny
J
Ploeg
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000191:economics*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000639:trends*; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011159:Population Surveillance; D012189:Retrospective Studies
Community-living older adults; Comorbidity; Diabetes; Health service costs; Health service utilization; Multimorbidity