Diabetes hospitalizations in the United States have been rising steadily since 2000. About half of all people with diabetes are now either visiting the emergency room or being hospitalized every year. Costs of hospitalization have increased as well, totaling about $85 billion in 2008.
We analyzed data from the US Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project on hospitalizations (Nationwide Inpatient Sample, 2000 through 2008) and emergency-room visits (Nationwide Emergency Department Sample, 2006 through 2008) by adult patients with diabetes. We estimated prevalence of diagnosed and undiagnosed diabetes based on data from the US Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System and the National Health and Nutrition Examination Survey and US Census Bureau population estimates.
We calculated annual rates of hospitalization and emergency-room visits for people with diabetes. We also calculated combined hospital encounters by adding up patients’ hospitalizations and emergency-room visits for 2006 through 2008 and adjusting for double counts from patients who both visited the emergency room and were hospitalized during the same visit.
The Nationwide Inpatient Sample included total hospital charges for each sampled hospitalization record. Using the Healthcare Cost and Utilization Project’s Cost-to-Charge Ratio Files to correct cost data (available from 2001 through 2008), we calculated cost per visit and total cost for patients with diabetes.
The key findings were as follows:
• Diabetes-related hospitalizations rose from 5.16 million in 2000 to 7.68 million in 2008—an increase of 49%. The annual rate over this period was rather stable, at around 27 hospitalizations per 100 persons with diabetes. (See Figures 1 and 2.)
• Diabetes-related emergency-room visits rose from 9.5 million in 2006 to 11.3 million 2008—an increase of 18%. The annual rate over this period rose from 36.5 to 40.6 visits per 100 persons with diabetes—an 11% increase.
• Combined hospital encounters rose from 11.9 million in 2006 to 13.6 million in 2008—an increase of 14%. The annual rate over this period rose from 45.5 to 48.9 encounters per 100 persons with diabetes—a 7% increase.
• Cost per visit increased by 39% from 2001 to 2008, and the total cost rose from $44 billion to $85 billon (a 93% increase), attributable to the increase in cost per visit and the total number of hospitalizations for persons with diabetes.
(See Table 1.)