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Observational Study
. 2023 Feb;25(2):454-467.
doi: 10.1111/dom.14889. Epub 2022 Nov 2.

Age-specific associations between the number of co-morbidities, all-cause mortality and public direct medical costs in patients with type 2 diabetes: A retrospective cohort study

Sabrina Nan Hong  1 , Ivy Lynn Mak  1 , Weng Yee Chin  1 , Esther Yee Tak Yu  1 , Emily Tsui Yee Tse  1 , Julie Yun Chen  1 , Carlos King Ho Wong  1   2   3 , David Vai Kiong Chao  4 , Wendy Wing Sze Tsui  5 , Cindy Lo Kuen Lam  1   6 , Eric Yuk Fai Wan  1   2   3
Affiliations
Observational Study

Age-specific associations between the number of co-morbidities, all-cause mortality and public direct medical costs in patients with type 2 diabetes: A retrospective cohort study

Sabrina Nan Hong et al. Diabetes Obes Metab. 2023 Feb.

Abstract

Aim: To evaluate the association between the number of co-morbidities, all-cause mortality and public health system expenditure in patients with type 2 diabetes (T2D) across different age groups.

Materials and methods: A retrospective observational study of T2D patients using electronic health records in Hong Kong was conducted. Patients were stratified by age (< 50, 50-64, 65-79, ≥ 80 years) and the number of co-morbidities (0, 1, 2, 3, ≥ 4), defined using the Charlson Comorbidity Index and prevalent chronic diseases identified in local surveys. The association between the number of co-morbidities, all-cause mortality and direct medical costs was examined using Cox proportional hazard regression and the gamma generalized linear model with log link function.

Results: A total of 262 212 T2D patients with a median follow-up of 10 years were included. Hypertension and dyslipidaemia were the most common co-morbidities in all age groups. After age stratification, cardiovascular diseases dominated the top pair of co-morbidities in the older age groups (65-79 and ≥ 80 years), while inflammatory and liver disease were predominant among younger individuals. Compared with co-morbidity-free T2D patients, the hazard ratios (95% CI) of death for patients aged younger than 50 and 80 years or older with two co-morbidities were 1.31 (1.08-1.59) and 1.25 (1.15-1.36), respectively, and increased to 3.08 (2.25-4.21) and 1.98 (1.82-2.16), respectively, as the number of co-morbidities increased to four or more. Similar trends were observed for medical costs.

Conclusions: Age-specific co-morbidity patterns were observed for patients with T2D. A greater number of co-morbidities was associated with increased mortality and healthcare costs, with stronger relationships observed among younger patients.

Keywords: database research diabetes complications population study primary care type 2 diabetes.

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References

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