Abstract
To evaluate cardiovascular disease (CVD) hospitalization risk in patients with diabetes based on their physician visits and blood-pressure control, we conducted a retrospective cohort study using healthcare claims, health checkup, and master data from the Fukuoka branch of the Japanese Health Insurance Association, covering the period from April 1, 2010, to March 31, 2017. We selected patients with diabetes from beneficiaries who underwent specific health checkups in 2010. The outcome was CVD hospitalization; the exposure was the frequency of diabetes-related outpatient visits. We classified patients into three groups according to diabetes-related outpatient-visit patterns during the 12 months following the 2010 health checkup: regular (≥4 visits with no interval between consecutive visits exceeding 3 months), irregular (1-3 visits, or ≥4 visits with any interval exceeding 3 months), and no visits. Kaplan-Meier survival curves were generated, and log-rank tests were performed. The Cox proportional hazards model was used to estimate hazard ratios and 95% confidence intervals (95% CIs). Among 7,414 participants, 3,307 (44.6%) were classified as having regular visits, 3,131 (42.2%) as irregular visits, and 976 (13.2%) as having no visits. According to the log-rank test, among participants with good blood-pressure control, those with fewer outpatient visits had a significantly shorter time to hospitalization (P = 0.019). According to the Cox proportional hazards model, the adjusted hazard ratios for the no-visit group compared to the regular-visit group were as follows: 2.18 (95% CI: 1.41-3.38, P < 0.001) overall; 2.12 (95% CI: 1.21-3.75, P = 0.009) in the good blood-pressure control group; and 2.21 (95% CI: 1.11-4.42, P = 0.025) in the poor blood-pressure control group. Regular medical visits and blood-pressure control are associated with a lower risk of CVD hospitalization. While regular blood glucose monitoring is important, timely initiation of therapeutic interventions remains essential.
