부산대학교 도서관

Background: Type 2 diabetes affects multiple systems. We aimed to compare age- and sex-specific rates of all-cause and cause-specific hospital bed-days between people with and without type 2 diabetes. Methods and findings: Data were provided by the Hong Kong Hospital Authority. We included 1,516,508 one-to-one matched people with incident type 2 diabetes (n = 758,254) and those without diabetes during the entire follow-up period (n = 758,254) between 2002 and 2018, followed until 2019. People with type 2 diabetes and controls were matched for age at index date (±2 years), sex, and index year (±2 years). We defined hospital bed-day rate as total inpatient bed-days divided by follow-up time. We constructed negative binominal regression models to estimate hospital bed-day rate ratios (RRs) by age at diabetes diagnosis and sex. All RRs were stratified by sex and adjusted for age and index year. During a median of 7.8 years of follow-up, 60.5% (n = 459,440) of people with type 2 diabetes and 56.5% (n = 428,296) of controls had a hospital admission for any cause, with a hospital bed-day rate of 3,359 bed-days and 2,350 bed-days per 1,000 person-years, respectively. All-cause hospital bed-day rate increased with increasing age in controls, but showed a J-shaped relationship with age in people with type 2 diabetes, with 38.4% of bed-days in those diagnosed <40 years caused by mental health disorders. Type 2 diabetes was associated with increased risks for a wide range of medical conditions, with an RR of 1.75 (95% CI [confidence interval] [1.73, 1.76]; p < 0.001) for all-cause hospital bed-days in men and 1.87 (95% CI [1.85, 1.89]; p < 0.001) in women. The RRs were greater in people with diabetes diagnosed at a younger than older age and varied by sex according to medical conditions. Sex differences were most notable for a higher RR for urinary tract infection and peptic ulcer, and a lower RR for chronic kidney disease and pancreatic disease in women than men. The main limitation of the study was that young people without diabetes in the database were unlikely to be representative of those in the Hong Kong general population with potential selection bias due to inclusion of individuals in need of medical care. Conclusions: In this study, we observed that type 2 diabetes was associated with increased risks of hospital bed-days for a wide range of medical conditions, with an excess burden of mental health disorders in people diagnosed at a young age. Age and sex differences should be considered in planning preventive and therapeutic strategies for type 2 diabetes. Effective control of risk factors with a focus on mental health disorders are urgently needed in young people with type 2 diabetes. Healthcare systems and policymakers should consider allocating adequate resources and developing strategies to meet the mental health needs of young people with type 2 diabetes, including integrating mental health services into diabetes care. In an observational cohort study, Hongjiang Wu and colleagues analyse data from more than 1.5 million people Hong Kong between 2002 and 2018 and compare age- and sex-specific rates of all-cause and cause-specific hospital bed-day rates in those with and without type 2 diabetes. Author summary: Why was this study done?: Previous studies examining the association between type 2 diabetes and medical conditions focused on the risk of time-to-first event, which does not capture an individual's disease burden, as many medical conditions can lead to multiple hospital admissions. Hospital bed-day rate, defined as cumulative inpatient bed-days per person-time, is a health metric that provides direct estimates on risk of total bed-days associated with a medical condition and indirectly reflects disease severity and inpatient resource use. The association between type 2 diabetes and all-cause and cause-specific hospital bed-day rates remains unclear. What did the researchers do and find?: We analysed data from 758,254 people with incident type 2 diabetes and 758,254 matched controls without diabetes in Hong Kong between 2002 and 2018. We compared age- and sex-specific rates of all-cause and cause-specific hospital bed-day rates between the 2 groups. All-cause hospital bed-day rate increased with increasing age in controls, but showed a J-shaped relationship with age in people with type 2 diabetes. Among people with type 2 diabetes diagnosed <40 years, 38.4% of hospital bed-days were caused by mental health disorders. Type 2 diabetes was associated with increased risks of hospital bed-day rate for a wide range of medical conditions, with the rate ratios (RRs) greater in people with diabetes diagnosed at a younger than older age and varied by sex according to medical conditions. Compared to men, women had a significantly higher RR for urinary tract infection and peptic ulcer but a lower RR for chronic kidney disease and pancreatic disease. What do these findings mean?: It is crucial to consider age and sex differences when planning preventive and therapeutic strategies for type 2 diabetes to reduce hospital bed-days. Efforts to provide integrated care and effectively manage risk factors, with a focus on mental health disorders, are urgently needed in young people with type 2 diabetes. [ABSTRACT FROM AUTHOR]