Disparities in diabetes-related avoidable hospitalization among diabetes patients with disability using a nationwide cohort study

Abstract

Diabetes is an ambulatory care sensitive condition that quality of care can prevent complications development and hospitalization needs. However, diabetes patients with disability face greater challenges with receiving quality diabetes care than those without disabilities. This study examined diabetes-related avoidable hospitalizations (DRAH) focusing on the association with disability. We used nationally representative health insurance cohort data from 2002 to 2013. The study population is people who were newly diagnosed with type 2 diabetes. We measured the cumulated number of DRAH using the Prevention Quality Indicators (PQIs). The variables of interest were disability severity and type. We performed a recurrent events analysis using Cox proportional hazard regression model. Among 49,410 type 2 diabetes patients, 12,231 (24.8%) experienced DRAHs at least once during the follow-up period. Among the total population, 5924 (12.0%) diabetes patients were registered as disabled. The findings report that disability severity was significantly associated with higher risks for DRAH, where severely disabled diabetes patients showed the highest hazard ratio of 2.24 (95% CI 1.80–2.79). Among three DRAH indicators, severely disabled diabetes patients showed increased risks for long-term (AHR 2.21, 95% CI 1.89–2.60) and uncontrolled (AHR 2.28, 95% CI 1.80–2.88) DRAH. In addition, intellectual (AHR 5.52, 95% CI 3.78–8.05) and mental (AHR 3.97, 95% CI 2.29–6.89) disability showed higher risks than other types of disability. In conclusion, diabetes patients with disability are at higher risk for DRAH compared to those without disabilities, and those with intellectual and mental disabilities were more likely to experience DRAH compared to those with physical or other types of disability. These findings call for action to find the more appropriate interventions to improve targeted diabetes primary care for patients with disability. Further research is needed to better understand determinants of increasing risks of DRAH.

Fact Sheet of Amputee 10-Year Trends in Korea: From 2011 to 2020

“…In this study, it is presumed that trauma, the main cause of amputation, was largely reflected because the prevalence of upper extremity amputation, which had a rather high rate of trauma as the cause, was high. Overall, the increase in amputations due to dysvascular disease is consistent with the results of previous studies [1,9,13].…”

“…Disabled people have a higher prevalence of chronic diseases than non-disabled people, because of mobility restrictions and insufficient medical services. According to the Korea national data in 2018, 19.1% of disabled people were diagnosed with diabetes, while 11.1% of non-disabled people had diabetes, and the need for regular monitoring of diabetic risk factors was emphasized [ 9 , 10 ]. Amputation may affect the quality of life depending on the amputation level.…”

Expanding outpatient benefits package can reduce diabetes-related avoidable hospitalizations

“…The inclusion and exclusion criteria for DRAHs were defined in detail by OECD ( 10 ). OECD indicators provide guidance for comparing the performance of health systems among member countries, making avoidable hospitalizations comparable across countries and facilitating cross-country comparisons of avoidable hospitalizations ( 23 , 24 ). The single DRAHs indicator of the OECD is created by combining three widely used avoidable hospitalization indicators for people with diabetes as follows: uncontrolled diabetes without complications, diabetes with short-term complications, and diabetes with long-term complications.…”

Overcoming barriers to technology in special groups

“…People with learning disability (LD) are approximately three times more likely to develop diabetes, and are more likely to be admitted to hospital with avoidable diabetes-related complications. 1 Individuals with diabetes and LD face unique challenges, and a patient-centred approach, with reasonable adjustments and accessibility to patient education, is essential. 2 Health care professionals can hold strong, often incorrect, views regarding who should be allowed access to new diabetes technologies, and who can understand them.…”