Abstract
Objectives
The primary objective of this study was to examine whether physical activity, diet, and smoking behaviours are associated with health resource utilization and costs in the Canadian context. A secondary objective was to evaluate demographic and health behavioural characteristics of the participants of the study to assess the degree of respondent bias.
Methods
Self-reported physical activity, diet and smoking status were obtained from a large population-based sample of adults with diabetes (N=2311). Resource utilization and cost information was obtained by linking these data to the provincial government’s administrative database. Multiple regression models examined predictors of resource utilization and costs for individuals with type 1 (T1D) and type 2 (T2D) diabetes separately. To assess the degree of responder bias, characteristics of individuals who consented to link data were compared with those who did not consent.
Results
Various measures of health care utilization and costs were negatively associated with physical activity behaviour in both T1D and T2D groups. Ever having smoked cigarettes was associated with higher resource utilization in individuals with T2D when controlling for demographic and health variables. Significant differences in demographic and health behavioural characteristics of the participants who provided consent for data linkage and those who did not were also found.
Conclusion
These findings are of interest considering that PA is a critical but understudied component of individuals with diabetes, and this appears to be one of the first studies to directly examine the relationship between health-related behaviours and health care utilization and costs. The findings may be useful in guiding targeted health promotion programs for individuals with diabetes. The results also indicate that studies involving linkage of administrative and survey data could be over-represented by healthy individuals.
Key words: Diabetes mellitus type 1, diabetes mellitus type 2, health behaviour, health care costs
Résumé
Objectifs
Notre étude visait principalement à déterminer si l’activité physique, le régime et l’usage du tabac sont associés à l’utilisation et aux coûts des ressources en santé dans le contexte canadien. Accessoirement, nous avons analysé le profil démographique et les habitudes de santé des participants de l’étude pour déterminer l’importance du biais statistique.
Méthode
Nous avons obtenu des données auto-déclarées sur l’activité physique, le régime et l’usage du tabac auprès d’un vaste échantillon représentatif d’adultes diabétiques (n=2 311). Les données sur l’utilisation et les coûts des ressources ont été obtenues en effectuant des maillages avec la base de données administratives du gouvernement provincial. À l’aide de modèles de régression multiple, nous avons examiné les variables prédictives de l’utilisation et des coûts des ressources pour les personnes atteintes du diabète de type I (DT1) et pour celles atteintes du diabète de type II (DT2). Pour déterminer le biais statistique, nous avons comparé les caractéristiques des personnes ayant consenti à nous donner accès à leurs données administratives et celles des personnes n’ayant pas donné leur consentement.
Résultats
Diverses mesures de l’utilisation et des coûts des soins de santé étaient liées négativement à l’activité physique dans les deux groupes (DT1 et DT2). Compte tenu des effets des variables démographiques et de santé, le fait d’avoir déjà fumé la cigarette était associé à une plus forte utilisation des ressources chez les personnes ayant le DT2. Nous avons également observé des écarts significatifs dans le profil démographique et les habitudes de santé des participants ayant consenti au maillage des données et de ceux qui n’y ont pas consenti.
Conclusion
Ces constatations sont intéressantes, car l’activité physique est un élément crucial, mais insuffisamment étudié, du profil des personnes diabétiques, et notre étude semble être l’une des premières à avoir examiné directement la relation entre les habitudes de santé et l’utilisation et les coûts des soins de santé. L’étude pourrait donc servir à orienter les programmes de promotion de la santé qui ciblent les diabétiques. Il semble aussi, d’après nos résultats, que les sujets en bonne santé pourraient être sur-représentés dans les études qui comportent des maillages de données administratives et de données d’enquête.
Mots clés: diabète de type I, diabète de type II, habitudes de santé, coûts des soins de santé
Footnotes
Acknowledgements: Dr. Plotnikoff is supported from Salary Awards from the Canadian Institutes of Health Research (Applied Public Health Chair Program) and the Alberta Heritage Foundation for Medical Research (AHFMR). Dr. Johnson holds a Canada Research Chair in Diabetes Health Outcomes and is a Health Scholar with AHFMR.
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