Risk of hospital admission or emergency department presentation due to diabetes complications: a retrospective cohort study in Tasmania, Australia
Ngan T. T. Dinh
A B , Barbara de Graaff A , Julie A. Campbell A , Matthew D. Jose C D , John Burgess C E , Timothy Saunder C , Alex Kitsos C , Petr Otahal A and Andrew J. Palmer A *
A Menzies Institute for Medical Research, University of Tasmania, Tas., Australia.
B Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen University, Thai Nguyen, Vietnam.
C School of Medicine, University of Tasmania, Tas., Australia.
D Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), SA, Australia.
E Department of Endocrinology, Royal Hobart Hospital, Tas., Australia.
Australian Health Review 47(3) 282-290 https://doi.org/10.1071/AH22271
Submitted: 25 November 2022 Accepted: 11 April 2023 Published: 4 May 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
Abstract
Objective To estimate the risk of an emergency department (ED)/inpatient visit due to complications in people with diabetes and compare them to their non-diabetes counterparts.
Methods This matched retrospective cohort study used a linked dataset in Tasmania, Australia for the 2004–17 period. People with diabetes (n = 45 378) were matched on age, sex and geographical regions with people without diabetes (n = 90 756) based on propensity score matching. The risk of an ED/inpatient visit related to each complication was estimated using negative binomial regression.
Results In people with diabetes, the combined ED and admission rates per 10 000 person-years were considerable, especially for macrovascular complications (ranging from 31.8 (lower extremity amputation) to 205.2 (heart failure)). The adjusted incidence rate ratios of ED/inpatient visits were: retinopathy 59.1 (confidence interval 25.8, 135.7), lower extremity amputation 11.1 (8.8, 14.1), foot ulcer/gangrene 9.5 (8.1, 11.2), nephropathy 7.4 (5.4, 10.1), dialysis 6.5 (3.8, 10.9), transplant 6.3 (2.2, 17.8), vitreous haemorrhage 6.0 (3.7, 9.8), fatal myocardial infarction 3.4 (2.3, 5.1), kidney failure 3.3 (2.3, 4.5), heart failure 2.9 (2.7, 3.1), angina pectoris 2.1 (2.0, 2.3), ischaemic heart disease 2.1 (1.9, 2.3), neuropathy 1.9 (1.7, 2.0), non-fatal myocardial infarction 1.7 (1.6, 1.8), blindness/low vision 1.4 (0.8, 2.5), non-fatal stroke 1.4 (1.3, 1.6), fatal stroke 1.3 (0.9, 2.1) and transient ischaemic attack 1.1 (1.0, 1.2).
Conclusions Our results demonstrated the high demand on hospital services due to diabetes complications (especially macrovascular complications) and highlighted the importance of preventing and properly managing microvascular complications. These findings will support future resource allocation to reduce the increasing burden of diabetes in Australia.
Keywords: admission, Australia, complications, data linkage, diabetes, emergency department, hospitalisation, record linkage, risk, Tasmania.
References
[1] Welborn TA, Knuiman MW, Bartholomew HC, Whittall DE. 1989–90 National Health Survey: prevalence of self-reported diabetes in Australia. Med J Aust 1995; 163 129–32.| 1989–90 National Health Survey: prevalence of self-reported diabetes in Australia.Crossref | GoogleScholarGoogle Scholar |
[2] Diabetes Australia. Australian Diabetes Map. Canberra: Diabetes Australia; 2022. Available at https://map.ndss.com.au/#!/ [cited 18 November 2022].
[3] Australian Bureau of Statistics. 3303.0 - Causes of Death, Australia, 2017. Canberra: Australian Bureau of Statistics; 2018. Available at https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3303.0Main+Features12017?OpenDocument [cited 24 January 2022].
[4] Comino EJ, Harris MF, Islam MDF, Tran DT, Jalaludin B, Jorm L, et al. Impact of diabetes on hospital admission and length of stay among a general population aged 45 year or more: a record linkage study. BMC Health Serv Res 2015; 15 12–25.
| Impact of diabetes on hospital admission and length of stay among a general population aged 45 year or more: a record linkage study.Crossref | GoogleScholarGoogle Scholar |
[5] Björk S. The cost of diabetes and diabetes care. Diabetes Res Clin Pract 2001; 54 13–8.
| The cost of diabetes and diabetes care.Crossref | GoogleScholarGoogle Scholar |
[6] Tomlin AM, Tilyard MW, Dovey SM, Dawson AG. Hospital admissions in diabetic and non-diabetic patients: a case-control study. Diabetes Res Clin Pract 2006; 73 260–7.
| Hospital admissions in diabetic and non-diabetic patients: a case-control study.Crossref | GoogleScholarGoogle Scholar |
[7] Lin W, Chen C, Guan H, Du X, Li J. Hospitalization of elderly diabetic patients: characteristics, reasons for admission, and gender differences. BMC Geriatr 2016; 16 160
| Hospitalization of elderly diabetic patients: characteristics, reasons for admission, and gender differences.Crossref | GoogleScholarGoogle Scholar |
[8] Chaikledkaew U, Pongchareonsuk P, Chaiyakunapruk N, Ongphiphadhanakul B. Factors Affecting Health-Care Costs and Hospitalizations among Diabetic Patients in Thai Public Hospitals. Value Health 2008; 11 S69–74.
| Factors Affecting Health-Care Costs and Hospitalizations among Diabetic Patients in Thai Public Hospitals.Crossref | GoogleScholarGoogle Scholar |
[9] Donnan PT, Leese GP, Morris AD. Hospitalizations for people with type 1 and type 2 diabetes compared with the nondiabetic population of Tayside, Scotland: a retrospective cohort study of resource use. Diabetes Care 2000; 23 1774–9.
| Hospitalizations for people with type 1 and type 2 diabetes compared with the nondiabetic population of Tayside, Scotland: a retrospective cohort study of resource use.Crossref | GoogleScholarGoogle Scholar |
[10] Nedkoff L, Knuiman M, Hung J, Briffa TG. Comparative Trends in the Incidence of Hospitalized Myocardial Infarction and Coronary Heart Disease in Adults With and Without Diabetes Mellitus in Western Australia From 1998 to 2010. Circ Cardiovasc Qual Outcomes 2014; 7 708–17.
| Comparative Trends in the Incidence of Hospitalized Myocardial Infarction and Coronary Heart Disease in Adults With and Without Diabetes Mellitus in Western Australia From 1998 to 2010.Crossref | GoogleScholarGoogle Scholar |
[11] Dillon MP, Fortington LV, Akram M, Erbas B, Kohler F. Geographic Variation of the Incidence Rate of Lower Limb Amputation in Australia from 2007–12. PLoS One 2017; 12 e0170705
| Geographic Variation of the Incidence Rate of Lower Limb Amputation in Australia from 2007–12.Crossref | GoogleScholarGoogle Scholar |
[12] Davis WA, Gregg EW, Davis TME. Temporal Trends in Cardiovascular Complications in People With or Without Type 2 Diabetes: The Fremantle Diabetes Study. J Clin Endocrinol Metab 2020; 105 e2471–82.
| Temporal Trends in Cardiovascular Complications in People With or Without Type 2 Diabetes: The Fremantle Diabetes Study.Crossref | GoogleScholarGoogle Scholar |
[13] Lee CMY, Goode B, Nørtoft E, Shaw JE, Magliano DJ, Colagiuri S. The cost of diabetes and obesity in Australia. J Med Econ 2018; 21 1001–5.
| The cost of diabetes and obesity in Australia.Crossref | GoogleScholarGoogle Scholar |
[14] Karahalios A, Somarajah G, Hamblin PS, Karunajeewa H, Janus ED. Quantifying the hidden healthcare cost of diabetes mellitus in Australian hospital patients. Intern Med J 2018; 48 286–92.
| Quantifying the hidden healthcare cost of diabetes mellitus in Australian hospital patients.Crossref | GoogleScholarGoogle Scholar |
[15] Lee CMY, Colagiuri R, Magliano DJ, Cameron AJ, Shaw J, Zimmet P, et al. The cost of diabetes in adults in Australia. Diabetes Res Clin Pract 2013; 99 385–90.
| The cost of diabetes in adults in Australia.Crossref | GoogleScholarGoogle Scholar |
[16] Clarke P, Kelman C, Colagiuri S. Factors influencing the cost of hospital care for people with diabetes in Australia. J Diabetes Complications 2006; 20 349–55.
| Factors influencing the cost of hospital care for people with diabetes in Australia.Crossref | GoogleScholarGoogle Scholar |
[17] Clarke P, Leal J, Kelman C, Smith M, Colagiuri S. Estimating the cost of complications of diabetes in Australia using administrative health-care data. Value Health 2008; 11 199–206.
| Estimating the cost of complications of diabetes in Australia using administrative health-care data.Crossref | GoogleScholarGoogle Scholar |
[18] Australian Bureau of Statistics. Snapshot of Tasmania. 2022. Available at https://www.abs.gov.au/articles/snapshot-tas-2021 [cited 4 July 2022].
[19] Australian Bureau of Statistics. 2071.0 - Census of Population and Housing: Reflecting Australia - Stories from the Census, 2016. 2018. Available at https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0~2016~Main%20Features~Socio-Economic%20Advantage%20and%20Disadvantage~123 [cited 4 July 2022].
[20] Johnson PJ, Ghildayal N, Ward AC, Westgard BC, Boland LL, Hokanson JS. Disparities in potentially avoidable emergency department (ED) care: ED visits for ambulatory care sensitive conditions. Med Care 2012; 50 1020–8.
| Disparities in potentially avoidable emergency department (ED) care: ED visits for ambulatory care sensitive conditions.Crossref | GoogleScholarGoogle Scholar |
[21] Dinh NTT, de Graaff B, Campbell JA, Jose MD, Burgess J, Saunder T, et al. Incremental healthcare expenditure attributable to diabetes mellitus: A cost of illness study in Tasmania, Australia. Diabet Med 2022; 39 e14817
| Incremental healthcare expenditure attributable to diabetes mellitus: A cost of illness study in Tasmania, Australia.Crossref | GoogleScholarGoogle Scholar |
[22] Saunder T, Kitsos A, Radford J, Jose K, McKercher C, Raj R, et al. Chronic kidney disease in Tasmania: Protocol for a data linkage study. JMIR Res Protoc 2020; 9 e20160
| Chronic kidney disease in Tasmania: Protocol for a data linkage study.Crossref | GoogleScholarGoogle Scholar |
[23] Dinh NTT, de Graaff B, Campbell JA, Jose MD, John B, Saunder T, et al. Costs of major complications in people with and without diabetes in Tasmania, Australia. Aust Health Rev 2022; 46 667–78.
| Costs of major complications in people with and without diabetes in Tasmania, Australia.Crossref | GoogleScholarGoogle Scholar |
[24] Oster A, Bindman AB. Emergency department visits for ambulatory care sensitive conditions: insights into preventable hospitalizations. Med Care 2003; 41 198–207.
| Emergency department visits for ambulatory care sensitive conditions: insights into preventable hospitalizations.Crossref | GoogleScholarGoogle Scholar |
[25] Berkowitz SA, Meigs JB, Dewalt D, Seligman HK, Barnard LS, Bright O-JM, et al. Material Need Insecurities, Control of Diabetes Mellitus, and Use of Health Care Resources. JAMA Intern Med 2015; 175 257–65.
| Material Need Insecurities, Control of Diabetes Mellitus, and Use of Health Care Resources.Crossref | GoogleScholarGoogle Scholar |
[26] Australian Bureau of Statistics. 2033.0.55.001 - Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2016. Canberra: Australian Bureau of Statistics; 2018. Available at https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2033.0.55.001~2016~Main%20Features~IRSD~19 [cited 31 December 2021].
[27] Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol 2004; 57 1288–94.
| New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality.Crossref | GoogleScholarGoogle Scholar |
[28] Stagg V. CHARLSON: Stata module to calculate Charlson index of comorbidity. 2017. Available at https://econpapers.repec.org/software/bocbocode/s456719.htm
[29] Cameron AC, Trivedi PK. Regression Analysis of Count Data, 2nd edn. Cambridge: Cambridge University Press; 2013.
[30] Carey IM, Critchley JA, Dewilde S, Harris T, Hosking FJ, Cook DG. Risk of Infection in Type 1 and Type 2 Diabetes Compared With the General Population: A Matched Cohort Study. Diabetes Care 2018; 41 513–21.
| Risk of Infection in Type 1 and Type 2 Diabetes Compared With the General Population: A Matched Cohort Study.Crossref | GoogleScholarGoogle Scholar |
[31] Tasmanian Data Linkage Unit. Datasets Available. 2023. Available at https://www.menzies.utas.edu.au/research/research-centres/data-linkage-unit/datasets-available
