Excess Burden of Inpatient Admissions and Emergency Department Visits Associated With Diabetes Across the Age Spectrum

OBJECTIVE: The epidemiology of diabetes and its complications is changing due to increasingly younger ages of diagnosis and increased life expectancy. How this changing landscape affects health care use, and for which conditions, is unclear. We examined age-specific excess burdens of cause-specific inpatient and emergency department (ED) visits associated with diabetes. RESEARCH DESIGN AND METHODS: We used 2019 Behavioral Risk Factor Surveillance System, National Inpatient Sample, and Nationwide Emergency Department Sample data to derive national U.S. estimates of inpatient admissions and ED visits in adults with and without diabetes. Complications were categorized as traditional, conditions emerging as diabetes associated, or other conditions co-occurring with diabetes. We calculated age-standardized absolute risk differences (ARDs) in people with versus without diabetes to identify leading causes of diabetes-related hospital use by age and setting. RESULTS: Traditional complications were dominated by sepsis, cardiorenal disease, acute kidney failure, myocardial infarction, and stroke, with ARDs ranging from 296 to 2,623 per 100,000 people with diabetes. Emerging conditions included pneumonia, device- and procedure-related complications (ARD range 125-473), and schizoaffective or other mental health disorders in younger adults only (ARD range 80-312). Other conditions included respiratory and fluid/electrolyte disorders across all ages (ARD range 100-363), while digestive and urinary disorders were more prominent in older adults (ARD range 229-482). ED visits showed a similar pattern, with lower ARD than inpatient admissions (ARD range 101-707). CONCLUSIONS: Diabetes drives substantial, age-specific excess inpatient and ED use, increasingly due to nontraditional rather than classic vascular and renal complications.