Background: Diabetes mellitus is highly prevalent in Malaysia and places a substantial burden on outpatient care in the country’s mixed public-private system. Outpatient healthcare utilization (OPHCU) is higher among individuals with diabetes than those without, reflecting complex disease management and frequent comorbidities, consistent with Andersen’s behavioral model in which diabetes functions as a need factor for care. Population-level estimates of outpatient utilization by provider sector and across socio-demographic, socio-economic, and comorbidity strata, however, remain limited, and this study addresses these gaps using nationally representative survey data.
Methods: A cross-sectional study was conducted using data from 18,616 Malaysian adults aged 18–90 years, drawn from the 2015 National Health and Morbidity Survey. Diabetes was identified through self-report, laboratory results, or medication use. OPHCU was defined as visits to non-hospital outpatient care providers within the past 2 weeks. Sociodemographic and clinical variables (age, sex, ethnicity, income, marital status, education, comorbidities) were analyzed. Multivariable logistic and multinomial regression examined associations and effect modification.
Results: Diabetics use more OPHCU with [adjusted odds ratio (aOR) =1.23; 95% confidence interval (CI): 1.05–1.43; P=0.008] compared to non-diabetics. Greater utilization was observed in Malay ethnicity (aOR =1.28), lower income [< ringgit Malaysia (RM)1,500; aOR =1.25], unmarried status (aOR =1.34), and absence of hypercholesterolemia (aOR =1.73). Age, sex, and education did not have a significant effect. Relative risk analysis confirmed that people living with diabetes were 1.44 times more likely to use public OPHCU compared to non-diabetics.
Conclusions: People living with diabetes utilized outpatient healthcare more than non-diabetics, with disparities by ethnicity, income, and marital status. Public-sector OPHCU predominated. Addressing utilization disparities through integrated policies is key to optimizing diabetes management in Malaysia.
