Trends and Demographic Disparities in Diabetes Hospital Admissions: Analyses of Serial Cross-Sectional National and State Data, 2008–2017

Abstract

OBJECTIVE To analyze national and state-specific trends in diabetes-related hospital admissions and determine whether disparities in rates of admission exist between demographic groups and geographically dispersed states. RESEARCH DESIGN AND METHODS We conducted serial cross-sectional analyses of the National Inpatient Sample (2008, 2011, 2014, and 2016) and State Inpatient Databases for Arizona, Florida, Kentucky, Iowa, Maryland, Nebraska, New Jersey, New York, North Carolina, Utah, and Vermont for 2008, 2011, 2014, and 2016/2017 among adult patients with type 1 and type 2 diabetes–related ICD codes (ICD-9 [250.XX] or ICD-10 [E10.XXX, E11.XXX, and E13.XXX]. We measured hospitalization rates for people with diabetes (all-cause hospitalizations) and for admissions with a primary diagnosis of diabetes or diabetes-related complications (diabetes-specific hospitalizations) per 10,000 persons per year. RESULTS Nationally, all-cause and diabetes-specific hospitalizations declined by 3.1% (95% CI −5.5, −0.7) and 19.1% (95% CI −21.6, −16.6), respectively, over 2008 to 2016. The analysis of individual states showed that diabetes-specific admissions in individuals ≥65 years old declined during this time (16.3–48.8% decrease) but increased among patients 18–29 years old (10.5–81.5% increase) and that rural diabetes-specific admissions decreased in just over half of the included states (15.2–69.2% decrease). There were no differences in changes in admission rates among different racial/ethnic groups. CONCLUSIONS Overall, rates of diabetes-related hospitalizations decreased over 2008 to 2016/2017, but there were large state-level differences across subgroups of patients. The rise in diabetes hospitalizations among young adults is a cause for concern. These state- and subpopulation-level differences highlight the need for state-level policies and interventions to address disparities in diabetes health care use.

Trends and Variations in Emergency Department Use Associated With Diabetes in the US by Sociodemographic Factors, 2008-2017

“…47 , 48 Furthermore, reported decreases in the rates of diabetes-related inpatient admissions in the context of increasing rates of all-cause treat-and-release ED visits may reflect increasing case acuity and use of ED services to manage this patient population. 48 , 49 …”

“…Diabetes complications, such as diabetic ketoacidosis, that primarily result in admissions to the ED are largely not represented in these trends because we examined treat-and-release ED visits. 49 Furthermore, as this was a trend analysis encompassing 2008 to 2017, the 2015 transition between the use of ICD-9-CM codes and the use of ICD-10-CM codes to identify diabetes-related ED visits may have introduced potential volatility in trends. Although we selected comparable ICD-9 and ICD-10 codes, the trends before and after the transition may be the result of actual changes in rates or the result of the transition.…”

“…47,48 Furthermore, reported decreases in the rates of diabetes-related inpatient admissions in the context of increasing rates of all-cause treat-and-release ED visits may reflect increasing case acuity and use of ED services to manage this patient population. 48,49 The rates of diabetes-specific ED visits were and persistently different by race and ethnicity. Black individuals visited the ED 3 times more than White individuals and approximately 2 times more than Hispanic individuals from 2008 to 2017, consistent with previous findings on racial disparities in diabetes-related ED use.…”

“…Increases in the rates of all-cause diabetes ED use may also reflect recently introduced incentives to capture comorbid conditions and to reduce inpatient admissions . Furthermore, reported decreases in the rates of diabetes-related inpatient admissions in the context of increasing rates of all-cause treat-and-release ED visits may reflect increasing case acuity and use of ED services to manage this patient population …”

“…As a result, patients who use ED services more frequently may be overrepresented in our sample. Diabetes complications, such as diabetic ketoacidosis, that primarily result in admissions to the ED are largely not represented in these trends because we examined treat-and-release ED visits . Furthermore, as this was a trend analysis encompassing 2008 to 2017, the 2015 transition between the use of ICD-9-CM codes and the use of ICD-10-CM codes to identify diabetes-related ED visits may have introduced potential volatility in trends.…”