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International Comparison of Health Resource Utilization in Subjects With Diabetes

An analysis of Canadian and American national health surveys

From the University of Alberta and Institute of Health Economics, Alberta, Canada

OBJECTIVE—To compare health resource utilization in patients with diabetes between the U.S. and Canada.

RESEARCH DESIGN AND METHODS—We combined measures of health care utilization, personal, demographic, health status, functional status, and comorbid conditions from the current National Health Interview Survey (U.S.) and the National Public Health Survey (Canada). A binary logistic regression analysis was used to examine how country of residence influences the probability of accessing health care resources in adult Caucasian subjects after controlling for potential confounders.

RESULTS—Subjects from Canada (n = 521) were more likely to have contact with a general physician (odds ratio [OR] 4.01, 95% CI 2.26–7.14), eye specialists (1.46, 1.08–1. 98), and any physician (3.02, 1.03–8.84) in the past year than their American counterparts (n = 825) but were less likely to have had contact with other medical specialists (0.33, 0.24–0.46). Subjects in Canada were also more likely to have been hospitalized overnight (1.79, 1.17–2.75) or to have contact with a health care professional in the previous 12 months (3.35, 1.01–12.81).

CONCLUSIONS—Significant disparities exist in health service utilization for adult Caucasian individuals with diabetes in Canada versus the U.S. after controlling for various confounders. From what is known regarding optimal treatment of diabetes, those with diabetes in the U.S. have a greater chance of not receiving recommended care.

Abbreviations: ADL, activity of daily living • DCCT, Diabetes Control and Complications Trial • NHIS, National Health Interview Survey • NPHS, National Population Health Survey • OR, odds ratio

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