Relationship of Health Services Utilization on Mortality among Middle-Aged and Older Adults with Diabetes Mellitus and Cardivascular Diseases

In the United States, Diabetes Mellitus (DM) becomes an important public health issue and has a great impact on health care costs. Diabetic patients are at a higher risk of developing cardiovascular diseases (CVD) compared to people without DM. Furthermore, diabetic patients with heart diseases or stroke are at higher risk of premature death. According to the statistics from the Centers for Disease Control and Prevention (CDC), heart diseases and stroke together accounted for 84% of DM-related death certificates among Americans aged 65 years or older in 2004. This study adopted the Andersen's Behavioral Model of Health Services Utilization as a framework to examine the association of health services uses and mortality within a representative sample of community-dwelling adults aged 51 years and older through a longitudinal analysis of the Health and Retirement Study data from 1998 through 2008. Results showed that most health services uses were associated with higher risk of 10-year mortality. People with DM and CVD had the greater hazard to death compared with people with DM only. The association between mortality and doctor visits after baseline, and hospitalizations after baseline was different by health groups. To our best knowledge, this is the first study examining the association of a broad range of health services use and subsequent mortality among people with diabetes and cardiovascular diseases. Our study findings can provide health care professionals and health care administrators the insight required for improving the health care practice and the quality of health care in the U.S.