• Kathryn Fisher, Lauren Griffith, Andrea Gruneir, Dilzayn Panjwani, Sima Gandhi, Li Lisa Sheng, Amiram Gafni, Patterson Chris, Maureen Markle-Reid, and Jenny Ploeg.
• School of Nursing, McMaster University, 1280 Main Street West, Health Sciences Centre Room, Hamilton, Ontario L8S 4K1, Canada. Electronic address: fisheka@mcmaster.ca.
• Diabetes Res. Clin. Pract. 2016 Dec 1; 122: 113-123.

AimsThis study describes the comorbid conditions in Canadian, community-dwelling older adults with diabetes and the association between the number of comorbidities and health service use and costs.MethodsThis retrospective cohort study used multiple linked administrative data to determine 5-year health service utilization in a population-based cohort of community-living individuals aged 66 and over with a diabetes diagnosis as of April 1, 2008 (baseline). Utilization included physician visits, emergency department visits, hospitalizations, and home care services.ResultsThere were 376,421 cohort members at baseline, almost all (95%) of which had at least one comorbidity and half (46%) had 3 or more. The most common comorbidities were hypertension (83%) and arthritis (61%). Service use and associated costs consistently increased as the number of comorbidities increased across all services and follow-up years. Conditions generally regarded as nondiabetes-related were the main driver of service use. Over time, use of most services declined for people with the highest level of comorbidity (3+). Hospitalizations and emergency department visits represented the largest share of costs for those with the highest level of comorbidity (3+), whereas physician visits were the main costs for those with fewer comorbidities.ConclusionsComorbidities in community-living older adults with diabetes are common and associated with a high level of health service use and costs. Accordingly, it is important to use a multiple chronic conditions (not single-disease) framework to develop coordinated, comprehensive and patient-centred programs for older adults with diabetes so that all their needs are incorporated into care planning.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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