Regional trends in avoidable hospitalisations due to complications among population with diabetes in Finland in 1996−2011: a register-based cohort study

ObjectivesDiabetes requires continuous medical care including prevention of acute complications and risk reduction for long-term complications. Diabetic complications impose a substantial burden on public health and care delivery. We examined trends in regional differences in hospitalisations due to diabetes-related complications among the total diabetes population in Finland.Research designA longitudinal register-based cohort study 1996−2011 among a total population with diabetes in Finland.ParticipantsAll persons with diabetes identified from several administrative registers in Finland in 1964−2011 and alive on 1 January 1996.Outcome measuresWe examined hospitalisations due to diabetes-related short-term and long-term complications, uncomplicated diabetes, myocardial infarction, stroke, lower extremity amputation and end-stage renal disease (ESRD). We calculated annual age-adjusted rates per 10 000 person years and the systematic component of variation. Multilevel models were used for studying time trends in regional variation.ResultsThere was a steep decline in complication-related hospitalisation rates during the study period. The decline was relatively small in ESRD (30%), whereas rates of hospitalisations for short-term and long-term complications as well as uncomplicated diabetes diminished by about 80%. The overall correlation between hospital district intercepts and slopes in time was −0.72 (p