IDF21-0131 What Is Driving Diabetes and Diabetes Complications in British Columbia (BC), Canada?

Abstract

Background: British Columbia (BC) is a Western Canadian province with 5.02 million people, ethnic diversity (Aboriginal, Chinese, South Asian) & >70% rural/remote/isolated geography. For 40 years, intermittent efforts in BC & Canada to improve chronic disease & diabetes management had little positive effect. Ideally, healthcare services & planning should be driven by strong data & evidence. No integrated system exists in BC to track, study, understand, manage & improve diabetes care. No comprehensive BC diabetes environmental scan has ever been conducted before. Aim: The BC Provincial Diabetes Evaluation is a quality improvement project to identify & better understand major gaps/barriers; & practical solutions for data-driven diabetes care management redesign in BC; so that all 470,000 diabetes people receive improved, timely, appropriate, cost-effective care that is locally/culturally/ethnically-sensitive, no matter where they live in BC. Method:1.Retrospective, open quantitative multi-source data analysis2.Prospective, open qualitative data analysis3.Knowledge Translation phase including Diabetes Heat Maps with diabetes performance measures; co-morbidities (*CKD, CAD, CHF); major procedures/surgeries (*renal dialysis, cardiac PCI, lower limb amputation) Results: BC’s geographical, socio-economic & lifestyle factors are drivers of diabetes & complications (by each of BC geographical health authority): • Fraser Health Authority (FHA): with BC’s highest population density, diabetes incidence & prevalence driven by BC's 2nd highest immigrant, non-English-speaking (ESL); highest South Asian population; & unhealthy lifestyle (diet, obesity, physical inactivity)#; associated with BC’s 2nd highest diabetes complications*, hospitalization cost & premature mortality; with an overall younger FHA population. • Northern Health Authority (NHA): with BC’s 2nd highest diabetes incidence & prevalence driven by highest rurality (64% of BC’s land mass), Aboriginal, low-education population; lifestyle# & smoking; associated with BC’s 2nd highest diabetes complications* & highest premature mortality; with an overall younger NHA population. • Vancouver Coastal Health Authority (VCHA): with BC’s highest immigrant, ESL, Chinese, low-income population; 2nd highest South Asian & BC population density; offset by a younger, healthier VCH population; associated with mid-range diabetes incidence & prevalence; & BC’s highest hospitalization cost. • Vancouver Island Health Authority (VIHA): BC’s highest elderly population; mid-range rurality, Aboriginal, immigrant, low-income population; associated with 2nd lowest incidence & prevalence; & BC’s lowest hospitalization cost. • Interior Health Authority (IHA): with BC’s 2nd highest elderly, Aboriginal, low-education population living alone; 2nd highest rurality; lowest ESL population; associated with BC’s lowest diabetes incidence & prevalence. Discussion: Substantial variation exists between BC's 5 geographical health authorities for diabetes outcomes, health determinants & cost. The current state of diabetes as an ambulatory-care-sensitive-condition indicates an inadequate primary healthcare system throughout BC & Canada. Barriers to accessing diabetes resources contributed to 80% of diabetes care provided by GPs in BC & Canada. BC has a higher reliance on physicians & lower usage of allied healthcare providers for diabetes care than other provinces. Without coordinated BC provincial diabetes care planning or services, a fragmented, non-standardized, patchwork system has resulted with negative health outcomes & high impact on BC's entire healthcare system (similar across Canada). Our BC Provincial Diabetes Evaluation Knowledge Translation findings will help with diabetes care management redesign; & improve the trajectory of diabetes, outcomes & healthcare utilization in BC.