Health care costs and mortality for Canadian urban and rural patients with diabetes: Population-based trends from 1993-2001

Background: Recent reports suggest that the health status of individuals residing in rural areas (as much as one third of the Canadian population) may be inferior to those who live in urban areas. Objective: This study compared trends in mortality and in provincial health care system costs for individuals with diabetes, according to urban/rural residence in Saskatchewan, Canada. Methods: The Canadian National Diabetes Surveillance System criteria were applied to the linked administrative databases of Saskatchewan Health to identify all individuals with diabetes between 1991 and 2001. Annual health care costs across 5 categories of health care services (physician visits, prescription medications, hospitalizations, day surgeries, and dialysis) were identified over a 9-year period (1993-2001). Costs (in 2001 Can $) and mortality rates were directly age adjusted, and comparisons were made across individuals residing in large urban, small urban, and rural areas. Results: A total of 57,774 individuals with diabetes were identified, approximately half (n = 26,656) of whom resided in rural areas. In 2001, total per capita costs were $3454 for large urban, $3427 for small urban, and $3289 for rural dwellers. Per capita costs of most individual categories were highest in large urban centers over the follow-up period with the exception of hospitalizations, which were highest among rural residents ($1444 vs $1283 for large urban residents). Despite differences in the individual cost categories, overall health care costs according to place of residence were similar. Overall, the age-adjusted mortality rates increased substantially from 12 (1993) to 18 (2001) deaths per 1000 population, although rates were similar across geographic locations. Conclusions: From 1993 to 2001, we observed systematic differences in costs of individual resource categories according to urban/rural residence in Saskatchewan with urban dwellers with diabetes incurring greater costs in most categories. Age-adjusted total costs and mortality rates were similar, however, suggesting that rural populations with diabetes may not be as disadvantaged as commonly believed. Investing in better primary care access for all patients with diabetes may reduce downstream costs in Saskatchewan's provincial health care system.