All-cause healthcare utilization among older adults with type 2 diabetes and cardiovascular and mental health comorbidities

BACKGROUND: The prevalence of cardiovascular (CVD) and mental health comorbidities (MHD) among individuals with diabetes is increasing. Pathological differences in these comorbidities may lead to differential healthcare utilization. This study’s objectives were to estimate the prevalence of CVD and MHD among older adults with type 2 diabetes (T2DM) and to assess all-cause healthcare utilization among these individuals. METHODS: A retrospective cohort analysis among Medicare-insured older individuals with T2DM was conducted. Four study cohorts were defined based on the presence of CVD and MHD. Healthcare utilization was measured as the number of visits. In addition to descriptive statistics, adjusted generalized linear models were fit and recycled predictions were employed to estimate the incremental utilization among study cohorts. RESULTS: Of 225,165 beneficiaries with T2DM, 53.30% (n=120,003) had neither CVD nor MHD, 23.98% (n=53,992) had CVD but no MHD, 12.05% (n=27,130) had MHD but no CVD, and 10.68% (n=24,040) had both CVD and MHD. Relative to beneficiaries with neither CVD nor MHD, those with CVD but no MHD had 0.11 higher mean inpatient, 2.29 higher mean outpatient, and 0.18 higher mean emergency department (ED) visits annually; those with MHD but no CVD had 0.22 higher mean inpatient, 8.78 higher mean outpatient, and 0.43 higher mean ED visits annually; those with both CVD and MHD had 0.31 higher mean inpatient, 7.53 higher mean outpatient, and 0.59 higher mean ED visits annually. Additionally, when compared to beneficiaries with CVD but no MHD, those with MHD but no CVD had 0.11 higher mean inpatient, 6.49 higher mean outpatient, and 0.25 higher mean ED visits annually. CONCLUSION: Older adults with T2DM and comorbidities use more healthcare services, especially those with MHD. The development and implementation of integrated care systems for management of chronic diseases and associated comorbidities will help in optimizing the use of healthcare resources.