Rural–urban differences in receiving guideline-recommended diabetes care and experiencing avoidable hospitalizations under a universal coverage health system: evidence from the past decade

Chen, C. C.; Chen, Li-Wu; Cheng, Shou‐Hsia

doi:10.1016/j.puhe.2017.06.009

Cited by 22 publications

(18 citation statements)

References 46 publications

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“…Hospitalizations for chronic ACSCs may more specifically indicate insufficient disease management [4][5][6][7][8][9]. Studies have characterized risk factors for ACSC hospitalizations including demographics [10][11][12][13][14][15][16][17][18][19], rurality [5,17,[20][21][22][23][24][25][26], socioeconomic status (SES) [1,5,[15][16][17][26][27][28][29][30][31][32][33][34][35][36][37][38], chronic morbidities [10,16,17,39], and health system characteristics [5,31,32,…”

Section: Introductionmentioning

confidence: 99%

Risk factors for avoidable hospitalizations in Canada using national linked data: A retrospective cohort study

Wallar

Rosella

2020

PLoS ONE

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Hospitalizations for certain chronic conditions are considered avoidable for adult Canadians given effective and timely primary care management. Individual-level risk factors such as income and health behaviours are not routinely collected in most hospital databases and as a result, are largely uncharacterized for avoidable hospitalization at the national level. The aim of this study was to identify and describe demographic, socioeconomic, and health behavioural risk factors for avoidable hospitalizations in Canada using linked data. A national retrospective cohort study was conducted by pooling eight cycles of the Canadian Community Health Survey (2000/2001-2011) and linking to hospitalization records in the Discharge Abstract Database (1999/2000-2012/2013). Respondents who were younger than 18 years and older than 74 years of age, residing in Quebec, or pregnant at baseline were excluded yielding a final cohort of 389,065 individuals. The primary outcome measure was time-to index avoidable hospitalization. Sex-stratified Cox proportional hazard models were constructed to determine effect sizes adjusted for various factors and their associated 95% confidence intervals. Demographics, socioeconomic status, and health behaviours are associated with risk of avoidable hospitalizations in males and females. In fully adjusted models, health behavioural variables had the largest effect sizes including heavy smoking (Male HR 2.65 (95% CI 2.17-3.23); Female HR 3.41 (2.81-4.13)) and being underweight (Male HR 1.98 (1.14-3.43); Female HR 2.78 (1.61-4.81)). Immigrant status was protective in both sexes (Male HR 0.83 (0.69-0.98); (Female HR 0.69 (0.57-0.84)). Adjustment for behavioural and clinical variables attenuated the effect of individual-level socioeconomic status. This study identified several risk factors for time-to-avoidable hospitalizations by sex, using the largest national database of linked health survey and hospitalization records. The larger effect sizes of several modifiable risk factors highlights the importance of prevention in addressing avoidable hospitalizations in Canada.

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Section: Introductionmentioning

confidence: 99%

Risk factors for avoidable hospitalizations in Canada using national linked data: A retrospective cohort study

Wallar

Rosella

2020

PLoS ONE

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“…Urban-rural differences in the incidence and relative risk of idiopathic cardiomyopathy in diabetes patients were rarely discussed before. Rural patients in Taiwan were older and had more chronic diseases than urban and suburban counterparts [25], but rural diabetes patients were less likely to receive guideline-recommended examinations or tests [26]. Although the universal health insurance has largely removed financial barriers to health care, the urban-rural disparity in prevalence of diabetic complications still exists after nearly two decades of implementation of the NHI program in Taiwan [27].…”

Section: Discussionmentioning

confidence: 99%

Incidence of Idiopathic Cardiomyopathy in Type 2 Diabetes Patients: Age, Sex, and Urbanization status stratified Analysis

Chen

Chang

et al. 2020

Preprint

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Background There are limited data regarding epidemiology of diabetes and idiopathic cardiomyopathy. We investigated the overall and age, sex, and urbanization-specific incidence and relative hazard of idiopathic cardiomyopathy in association with type 2 diabetes in Taiwan. Methods A total of 474,268 type 2 diabetes patients were identified from ambulatory care and inpatient claims in 2007–2009 from Taiwan’s National Health Insurance (NHI) database, and 474,266 age-, sex- and diagnosis date-matched controls were randomly selected from the registry of NHI beneficiaries. All study subjects were linked to ambulatory care and inpatient claims (up to the end of 2016) to identify possible diagnosis of idiopathic cardiomyopathy. The person-year approach with Poisson assumption was used to estimate the incidence; and Cox proportional hazard regression model with Fine and Gray’s method was used to estimate the relative hazards of idiopathic cardiomyopathy in relation to type 2 diabetes. Results The overall incidence of idiopathic cardiomyopathy for men and women patients, respectively, was 4.26 and 3.34/10,000 person-years, which were higher than the corresponding men and women controls (2.40 and 1.69 per 10,000 person-years). Compared with control group, type 2 diabetes patients were significantly associated with an increased hazard of idiopathic cardiomyopathy (adjusted hazard ratio [aHR] 1.39, 95% confidence interval [CI] 1.28–1.51] in all age and sex stratifications except in those aged > 64 years. Type 2 diabetes aged < 45 years confronted the greatest increase in hazard of idiopathic cardiomyopathy, with an aHR of 2.36 (95% CI 1.68–3.32) and 3.72 (95% CI 1.86–7.44) for men and women, respectively. Patients living in rural areas tended to have higher HRs of idiopathic cardiomyopathy. Conclusions In Taiwan, diabetes increased the risk of idiopathic cardiomyopathy in both sexes as well as in all age groups except in those > 64 years. Younger patients and those living in rural areas were especially vulnerable to have higher HRs of idiopathic cardiomyopathy.

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“…Urban-rural differences in the incidence and relative risk of idiopathic cardiomyopathy in patients with diabetes were rarely discussed before. Patients from rural areas in Taiwan are older and have more chronic diseases than their urban and suburban counterparts [36], but patients with diabetes who live in rural areas are less likely to receive guideline-recommended examinations or tests [37]. Although the universal health insurance has largely removed nancial barriers to health care, the urban-rural disparity in prevalence of diabetic complications still exists after nearly two decades of implementation of the NHI program in Taiwan [38].…”

Section: Discussionmentioning

confidence: 99%

Incidence of Idiopathic Cardiomyopathy in Patients with Type 2 Diabetes in Taiwan: Age, Sex, and Urbanization Status-stratified Analysis

Chen

Chang

et al. 2020

Preprint

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Background: The epidemiology of diabetes and idiopathic cardiomyopathy have limited data. We investigated the overall and the age-, sex-, and urbanization-specific incidence and relative hazard of idiopathic cardiomyopathy in association with type 2 diabetes and various anti-diabetic medications used in Taiwan.Methods: A total of 474,268 patients with type 2 diabetes were identified from ambulatory care and inpatient claims in 2007-2009 from Taiwan’s National Health Insurance (NHI) database. We randomly selected 474,266 age-, sex-, and diagnosis date-matched controls from the registry of NHI beneficiaries. All study subjects were linked to ambulatory care and inpatient claims (up to the end of 2016) to identify the possible diagnosis of idiopathic cardiomyopathy. The person-year approach with Poisson assumption was used to estimate the incidence, and Cox proportional hazard regression model with Fine and Gray’s method was used to estimate the relative hazards of idiopathic cardiomyopathy in relation to type 2 diabetes.Results: The overall incidence of idiopathic cardiomyopathy for men and women patients, respectively, was 3.83 and 2.94 per 10,000 person-years, which were higher than the corresponding men and women controls (2.00 and 1.34 per 10,000 person-years). Compared with the control group, patients with type 2 diabetes were significantly associated with an increased hazard of idiopathic cardiomyopathy (adjusted hazard ratio [aHR]: 1.60, 95% confidence interval [CI]: 1.45-1.77] in all age and sex stratifications except in those men aged >64 years. Patients with type 2 diabetes aged <45 years confronted the greatest increase in the hazard of idiopathic cardiomyopathy, with an aHR of 3.35 (95% CI: 2.21-5.06) and 3.48 (95% CI: 1.60-7.56) for men and women, respectively. The usage of some anti-diabetic medications revealed lower risks of idiopathic cardiomyopathy.Conclusions: In Taiwan, diabetes increased the risk of idiopathic cardiomyopathy in both sexes and in all age groups, except in men aged >64 years. Younger patients were vulnerable to have higher HRs of idiopathic cardiomyopathy. Some anti-diabetic medications may reduce the risks of cardiomyopathy.

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Rural–urban differences in receiving guideline-recommended diabetes care and experiencing avoidable hospitalizations under a universal coverage health system: evidence from the past decade

Cited by 22 publications

References 46 publications

Risk factors for avoidable hospitalizations in Canada using national linked data: A retrospective cohort study

Risk factors for avoidable hospitalizations in Canada using national linked data: A retrospective cohort study

Incidence of Idiopathic Cardiomyopathy in Type 2 Diabetes Patients: Age, Sex, and Urbanization status stratified Analysis

Incidence of Idiopathic Cardiomyopathy in Patients with Type 2 Diabetes in Taiwan: Age, Sex, and Urbanization Status-stratified Analysis

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