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Association of diabetes with frequency and cost of hospital admissions: a retrospective cohort study

Jin Choi, Gillian Booth, Hae Young Jung, Lauren Lapointe-Shaw, Terence Tang, Janice L. Kwan, Shail Rawal, Adina Weinerman, Amol Verma and Fahad Razak
April 16, 2021 9 (2) E406-E412; DOI: https://doi.org/10.9778/cmajo.20190213
Jin Choi
Department of Medicine (Choi), University of Toronto; Li Ka Shing Knowledge Institute (Booth, Jung, Verma, Razak) and Department of Medicine, Division of Endocrinology (Booth), St. Michael’s Hospital; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network; Program of Medicine and Institute for Better Health (Tang), Trillium Health Partners; Division of General Internal Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Verma, Razak), St. Michael’s Hospital, Toronto, Ont.
MD MSc
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Gillian Booth
Department of Medicine (Choi), University of Toronto; Li Ka Shing Knowledge Institute (Booth, Jung, Verma, Razak) and Department of Medicine, Division of Endocrinology (Booth), St. Michael’s Hospital; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network; Program of Medicine and Institute for Better Health (Tang), Trillium Health Partners; Division of General Internal Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Verma, Razak), St. Michael’s Hospital, Toronto, Ont.
MD MSc
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Hae Young Jung
Department of Medicine (Choi), University of Toronto; Li Ka Shing Knowledge Institute (Booth, Jung, Verma, Razak) and Department of Medicine, Division of Endocrinology (Booth), St. Michael’s Hospital; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network; Program of Medicine and Institute for Better Health (Tang), Trillium Health Partners; Division of General Internal Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Verma, Razak), St. Michael’s Hospital, Toronto, Ont.
MSc
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Lauren Lapointe-Shaw
Department of Medicine (Choi), University of Toronto; Li Ka Shing Knowledge Institute (Booth, Jung, Verma, Razak) and Department of Medicine, Division of Endocrinology (Booth), St. Michael’s Hospital; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network; Program of Medicine and Institute for Better Health (Tang), Trillium Health Partners; Division of General Internal Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Verma, Razak), St. Michael’s Hospital, Toronto, Ont.
MD PhD
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Terence Tang
Department of Medicine (Choi), University of Toronto; Li Ka Shing Knowledge Institute (Booth, Jung, Verma, Razak) and Department of Medicine, Division of Endocrinology (Booth), St. Michael’s Hospital; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network; Program of Medicine and Institute for Better Health (Tang), Trillium Health Partners; Division of General Internal Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Verma, Razak), St. Michael’s Hospital, Toronto, Ont.
MD
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Janice L. Kwan
Department of Medicine (Choi), University of Toronto; Li Ka Shing Knowledge Institute (Booth, Jung, Verma, Razak) and Department of Medicine, Division of Endocrinology (Booth), St. Michael’s Hospital; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network; Program of Medicine and Institute for Better Health (Tang), Trillium Health Partners; Division of General Internal Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Verma, Razak), St. Michael’s Hospital, Toronto, Ont.
MD MPH
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Shail Rawal
Department of Medicine (Choi), University of Toronto; Li Ka Shing Knowledge Institute (Booth, Jung, Verma, Razak) and Department of Medicine, Division of Endocrinology (Booth), St. Michael’s Hospital; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network; Program of Medicine and Institute for Better Health (Tang), Trillium Health Partners; Division of General Internal Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Verma, Razak), St. Michael’s Hospital, Toronto, Ont.
MD MPH
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Adina Weinerman
Department of Medicine (Choi), University of Toronto; Li Ka Shing Knowledge Institute (Booth, Jung, Verma, Razak) and Department of Medicine, Division of Endocrinology (Booth), St. Michael’s Hospital; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network; Program of Medicine and Institute for Better Health (Tang), Trillium Health Partners; Division of General Internal Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Verma, Razak), St. Michael’s Hospital, Toronto, Ont.
MD MHSc
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Amol Verma
Department of Medicine (Choi), University of Toronto; Li Ka Shing Knowledge Institute (Booth, Jung, Verma, Razak) and Department of Medicine, Division of Endocrinology (Booth), St. Michael’s Hospital; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network; Program of Medicine and Institute for Better Health (Tang), Trillium Health Partners; Division of General Internal Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Verma, Razak), St. Michael’s Hospital, Toronto, Ont.
MD MPhil
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Fahad Razak
Department of Medicine (Choi), University of Toronto; Li Ka Shing Knowledge Institute (Booth, Jung, Verma, Razak) and Department of Medicine, Division of Endocrinology (Booth), St. Michael’s Hospital; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network; Program of Medicine and Institute for Better Health (Tang), Trillium Health Partners; Division of General Internal Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Verma, Razak), St. Michael’s Hospital, Toronto, Ont.
MD MSc
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Article Figures & Tables

Figures

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    Figure 1:

    Prevalence ratios with error bars of most responsible reasons for diagnosis. Note: CI = confidence interval, COPD = chronic obstructive pulmonary disease, PR = prevalence ratio.

  • Figure 2:
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    Figure 2:

    Cost ratios with error bars of most responsible reasons for diagnosis. Note: CI = confidence interval, COPD = chronic obstructive pulmonary disease, CR = cost ratio.

Tables

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    Table 1:

    Characteristics of study participants, stratified by diabetes status

    CharacteristicOverall
    n = 150 499
    Diabetes
    n = 41 934
    No diabetes
    n = 108 565
    Age, yr, median (IQR)73 (56–83)74 (63–82)72 (53–84)
    Female sex, no. (%)74 935 (49.7)22 366 (53.3)52 569 (48.4)
    No. of comorbidities, median (IQR)6 (3–8)7 (5–10)5 (3–8)
    Cost of admission in Can$, mean ± SD10 796 ± 25 31612 165 ± 27 27810 268 ± 24 497
    • Note: IQR = interquartile range, SD = standard deviation.

    • View popup
    Table 2:

    Prevalence and cost of admission for most common reasons for hospital admissions, stratified by diabetes status

    Most common reason for hospital admissionPrevalence, no. (%)*Cost of admission, median, Can$
    Overall
    n = 150 499
    Diabetes
    n = 41 934
    No diabetes
    n = 108 565
    OverallDiabetesNo diabetes
    Heart failure7675 (5.1)3228 (7.7)4447 (4.1)671668216670
    Urinary tract infection6902 (4.6)2139 (5.1)4763 (4.4)507154424427
    Stroke6652 (4.4)2020 (4.8)4632 (4.3)712282706922
    Pneumonia7465 (5.0)1929 (4.6)5536 (5.1)600961835902
    COPD6648 (4.4)1861 (4.4)4787 (4.4)614862786095
    Delirium4388 (2.9)1351 (3.2)3037 (2.8)12 83112 91612 700
    Acute renal failure2760 (1.8)1209 (2.9)1551 (1.4)623863016025
    Sepsis3710 (2.5)1189 (2.8)2521 (2.3)10 21610 72210 025
    Soft tissue and bone infections3144 (2.1)1038 (2.5)2106 (1.9)672187945845
    Electrolyte disorders3382 (2.2)1016 (2.4)2366 (2.2)376844223679
    • Note: COPD = chronic obstructive pulmonary disease.

    • ↵* Table rows arranged by descending order of prevalence among people with diabetes.

    • View popup
    Table 3:

    Most common reasons for hospital admission, stratified by increase in prevalence and cost of hospital admission

    Cost of admission in diabetes
    Increased*Not increased
    Prevalence of admission in diabetesIncreased*StrokeAcute renal failure
    Urinary tract infectionHeart failure
    Soft tissue and bone infectionsSepsis
    Electrolyte disordersDelirium
    Not increasedPneumonia COPD
    • Note: COPD = chronic obstructive pulmonary disease.

    • ↵* Both statistically significant at p < 0.05 and greater than 10% increase.

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CMAJ Open: 9 (2)
Vol. 9, Issue 2
1 Apr 2021
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Association of diabetes with frequency and cost of hospital admissions: a retrospective cohort study
Jin Choi, Gillian Booth, Hae Young Jung, Lauren Lapointe-Shaw, Terence Tang, Janice L. Kwan, Shail Rawal, Adina Weinerman, Amol Verma, Fahad Razak
Apr 2021, 9 (2) E406-E412; DOI: 10.9778/cmajo.20190213

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Association of diabetes with frequency and cost of hospital admissions: a retrospective cohort study
Jin Choi, Gillian Booth, Hae Young Jung, Lauren Lapointe-Shaw, Terence Tang, Janice L. Kwan, Shail Rawal, Adina Weinerman, Amol Verma, Fahad Razak
Apr 2021, 9 (2) E406-E412; DOI: 10.9778/cmajo.20190213
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