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National trends in diabetes mellitus hospitalization in Spain 1997–2010: Analysis of over 5.4 millions of admissions

  • Carmen M. Lara-Rojas
    Affiliations
    Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
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  • Luis M. Pérez-Belmonte
    Correspondence
    Corresponding author at: Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Avenida de Carlos Haya, s/n, Málaga, 29010, Spain.
    Affiliations
    Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain

    Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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  • María D. López-Carmona
    Affiliations
    Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
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  • Ricardo Guijarro-Merino
    Affiliations
    Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
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  • María R. Bernal-López
    Affiliations
    Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain

    Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
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  • Ricardo Gómez-Huelgas
    Affiliations
    Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain

    Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
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Published:August 09, 2018DOI:https://doi.org/10.1016/j.ejim.2018.04.005

      Highlights

      • Patients with diabetes mellitus are admitted to hospital more often.
      • Hospitalizations of patients with diabetes have gradually increased over time.
      • Heart failure and neoplasms are the main causes of hospitalizations for diabetics.
      • Hospitalized diabetic patients are progressively older and have more comorbidities.
      • Hospitalization trends for coronary and cerebrovascular disease are less pronounced.

      Abstract

      Aims

      To analyze national trends in the rates of hospitalizations (all-cause and by principal discharge diagnosis) in total diabetic population of Spain.

      Methods

      We carried out a nation-wide population-based study of all diabetic patients hospitalized between 1997 and 2010. All-cause hospitalizations, hospitalizations by principal discharge diagnosis, mean age, Charlson Comorbidity Index, readmission rates and length of hospital stay were examined. Annual rates adjusted for age and sex were analyzed and trends were calculated.

      Results

      Over 14-years-period, all-cause hospitalizations of diabetic patients increased significantly, with an average annual percentage change of 2.5 (95%CI: 1.5–3.5; Ptrend < 0.01). The greatest increase was observed in heart failure (5.4; 95%CI: 4.8–6.0; Ptrend < 0.001), followed by neoplasms (4.9; 95%CI: 3.6–5.8; Ptrend < 0.001), pneumonia (2.7; 95%CI: 2.0–4.0; Ptrend < 0.001), stroke (2.4; 95%CI: 1.6–3.4; Ptrend < 0.001), chronic obstructive pulmonary disease (2.0; 95%CI: 1.4–3.4; Ptrend < 0.001) and coronary artery disease (1.6; 95%CI: 1.1–2.3; Ptrend < 0.01). The adjusted number of all-cause hospitalizations of patients with diabetes per 100,000 inhabitants increased 2.6-fold. The increase in hospitalizations was significantly higher among patients ≥75 years old. Males experienced a greater increase in all-cause, neoplasm, heart failure, chronic obstructive pulmonary disease, and pneumonia hospitalizations (p < 0.01 for all). Hospitalized diabetic patients were progressively older and had more comorbidities, higher readmission rates and shorter hospital stays (p < 0.05 for all).

      Conclusions

      Hospitalizations of diabetic patients more than doubled in Spain during the study period. Heart failure and neoplasms experienced the greatest annual increases and remained the principal causes of hospitalization, probably associated with advanced age and comorbidities of hospitalized diabetics. Coronary and cerebrovascular diseases experienced a lower annual increase, suggesting an improvement in cardiovascular care in diabetes in Spain.

      Keywords

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