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Peer-reviewedCC BYInjury epidemiology

Diabetes mellitus and risk of injury requiring medical care: a nationwide population-based matched cohort study in Taiwan.

  • Yao-Ching Huang1,2,3
  • Ho-Tsung Hsin4
  • Wei-Ting Lin5
  • Tsu-Hsuan Weng2,6
  • Chi-Hsiang Chung2,3,7
  • Shi-Hao Huang1
  • Bing-Long Wang3
  • Pi-Ching Yu4,8
  • Pei-Yeh Yu9
  • Li-Yun Fann10,11,12,13
  • Wu-Chien Chien14,15,16,17,18
18 affiliations
  1. 1Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei, 10608, Taiwan.
  2. 2Department of Medical Research, Tri-Service General Hospital, National Defense Medical University, Taipei, 11490, Taiwan.
  3. 3Graduate Institute of Public Health, College of Public Health, National Defense Medical University, Taipei, 11490, Taiwan.
  4. 4Cardiovascular Intensive Care Unit, Department of Critical Care Medicine, Far-Eastern Memorial Hospital, New Taipei City, 10602, Taiwan.
  5. 5Department of Education, Taipei City Hospital, Taipei, 10684, Taiwan.
  6. 6Graduate Institute of Life Sciences, College of Biomedical Sciences, National Defense Medical University, Taipei, 11490, Taiwan.
  7. 7Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, 11490, Taiwan.
  8. 8Graduate Institute of Medicine, College of Medicine, National Defense Medical University, Taipei, 11490, Taiwan.
  9. 9Department of Anesthesiology, Taipei City Hospital Ren Ai branch, Taipei, 10684, Taiwan. [email protected].
  10. 10Department of Nursing, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, 231016, Taiwan. [email protected].
  11. 11Department of Nursing, College of Nursing, Tzu Chi University, Hualien City, 97074, Taiwan. [email protected].
  12. 12Department of Nurse-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei city hospital, Taipei, 10684, Taiwan. [email protected].
  13. 13Institute of Biology and Anatomy, College of Medicine, National Defense Medical University, Taipei, 114201, Taiwan. [email protected].
  14. 14Department of Medical Research, Tri-Service General Hospital, National Defense Medical University, Taipei, 11490, Taiwan. [email protected].
  15. 15Graduate Institute of Public Health, College of Public Health, National Defense Medical University, Taipei, 11490, Taiwan. [email protected].
  16. 16Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, 11490, Taiwan. [email protected].
  17. 17Graduate Institute of Medicine, College of Medicine, National Defense Medical University, Taipei, 11490, Taiwan. [email protected].
  18. 18Graduate Institute of Life Sciences, College of Biomedical Sciences, National Defense Medical University, Taipei, 11490, Taiwan. [email protected].
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Abstract

Background

Diabetes mellitus (DM) is associated with multiple microvascular and macrovascular complications; however, its association with clinically significant injury requiring medical care remains incompletely understood. This study aimed to investigate the association between DM and subsequent risk of injury requiring emergency department visits or hospitalization using a nationwide population-based cohort.Methods

We conducted a nationwide matched cohort study using Taiwan's National Health Insurance Research Database. Adults with newly diagnosed DM were identified and matched with individuals without DM at a 1:3 ratio using propensity score matching. The propensity score model incorporated demographic characteristics, socioeconomic factors, baseline comorbidities, healthcare utilization, and overall disease burden. Covariate balance after matching was assessed using standardized mean differences (SMDs), with SMD < 0.10 indicating adequate balance. The primary outcome was clinically significant injury requiring emergency department visits or hospitalization. Multivariable Cox proportional hazards models with robust variance estimation were used to evaluate the association between DM and injury risk.Results

After propensity score matching, 31,424 individuals with DM and 94,272 matched individuals without DM were included. All baseline covariates achieved adequate balance after matching, with standardized mean differences (SMDs) <0.10. During follow-up, clinically significant injury requiring emergency department visits or hospitalization occurred more frequently among individuals with DM than among those without DM. In multivariable Cox proportional hazards models accounting for the matched cohort design, DM was independently associated with an increased risk of clinically significant injury (adjusted hazard ratio [aHR], 1.645; 95% confidence interval [CI], 1.202-2.015; p<0.001). The association remained robust in sensitivity analyses and was consistent across subgroup analyses stratified by age and sex, with no significant evidence of effect modification.Conclusion

In this nationwide population-based matched cohort study, DM was associated with an increased risk of clinically significant injury requiring emergency or inpatient care. These findings highlight the importance of incorporating injury risk assessment into comprehensive diabetes management, particularly among individuals with increased vulnerability due to age, diabetes-related complications, or functional impairment. Further studies incorporating detailed clinical information, including glycemic control and diabetes severity, are warranted to clarify the mechanisms underlying this association.

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Cite

BibTeXRIS
BibTeX
@article{huang2026diabetes,
  title = {{Diabetes mellitus and risk of injury requiring medical care: a nationwide population-based matched cohort study in Taiwan.}},
  author = {Yao-Ching Huang and Ho-Tsung Hsin and Wei-Ting Lin and Tsu-Hsuan Weng and Chi-Hsiang Chung and Shi-Hao Huang and Bing-Long Wang and Pi-Ching Yu and Pei-Yeh Yu and Li-Yun Fann and Wu-Chien Chien},
  journal = {Injury epidemiology},
  year = {2026},
  month = aug,
  doi = {10.1186/s40621-026-00703-3},
  url = {https://europepmc.org/article/MED/42968186},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Diabetes mellitus and risk of injury requiring medical care: a nationwide population-based matched cohort study in Taiwan.
AU  - Yao-Ching Huang
AU  - Ho-Tsung Hsin
AU  - Wei-Ting Lin
AU  - Tsu-Hsuan Weng
AU  - Chi-Hsiang Chung
AU  - Shi-Hao Huang
AU  - Bing-Long Wang
AU  - Pi-Ching Yu
AU  - Pei-Yeh Yu
AU  - Li-Yun Fann
AU  - Wu-Chien Chien
PY  - 2026
DA  - 2026/08/05
JO  - Injury epidemiology
DO  - 10.1186/s40621-026-00703-3
UR  - https://europepmc.org/article/MED/42968186
AB  - Background  Diabetes mellitus (DM) is associated with multiple microvascular and macrovascular complications; however, its association with clinically significant injury requiring medical care remains incompletely understood. This study aimed to investigate the association between DM and subsequent risk of injury requiring emergency department visits or hospitalization using a nationwide population-based cohort.Methods  We conducted a nationwide matched cohort study using Taiwan's National Health Insurance Research Database. Adults with newly diagnosed DM were identified and matched with individuals without DM at a 1:3 ratio using propensity score matching. The propensity score model incorporated demographic characteristics, socioeconomic factors, baseline comorbidities, healthcare utilization, and overall disease burden. Covariate balance after matching was assessed using standardized mean differences (SMDs), with SMD < 0.10 indicating adequate balance. The primary outcome was clinically significant injury requiring emergency department visits or hospitalization. Multivariable Cox proportional hazards models with robust variance estimation were used to evaluate the association between DM and injury risk.Results  After propensity score matching, 31,424 individuals with DM and 94,272 matched individuals without DM were included. All baseline covariates achieved adequate balance after matching, with standardized mean differences (SMDs) <0.10. During follow-up, clinically significant injury requiring emergency department visits or hospitalization occurred more frequently among individuals with DM than among those without DM. In multivariable Cox proportional hazards models accounting for the matched cohort design, DM was independently associated with an increased risk of clinically significant injury (adjusted hazard ratio [aHR], 1.645; 95% confidence interval [CI], 1.202-2.015; p<0.001). The association remained robust in sensitivity analyses and was consistent across subgroup analyses stratified by age and sex, with no significant evidence of effect modification.Conclusion  In this nationwide population-based matched cohort study, DM was associated with an increased risk of clinically significant injury requiring emergency or inpatient care. These findings highlight the importance of incorporating injury risk assessment into comprehensive diabetes management, particularly among individuals with increased vulnerability due to age, diabetes-related complications, or functional impairment. Further studies incorporating detailed clinical information, including glycemic control and diabetes severity, are warranted to clarify the mechanisms underlying this association.
SN  - 2197-1714
ER  -