Diabetes mellitus and infection: an evaluation of hospital utilization and management costs in the United States

Abstract

Aims

The objective of this study is to evaluate the number of diabetics that seek medical treatment in emergency departments or require hospitalization for infection management in the United States. This study also assesses the socioeconomic impact of inpatient infection management among diabetics.

Methods

We accessed the Healthcare Cost and Utilization Project's Nationwide Emergency Department Sample database and the Nationwide Inpatient Sample database to perform a retrospective analysis on diabetics presenting to the emergency department or hospitalized for infection management from 2006 to 2011.

Results

Emergency Department: Since 2006, nearly 10 million diabetics were annually evaluated in the emergency department. Infection was the primary reason for presentation in 10% of these visits. Among those visits, urinary tract infection was the most common infection, accounting for over 30% of emergency department encounters for infections. Other common infections included sepsis, skin and soft tissue infections, and pneumonia. Diabetics were more than twice as likely to be hospitalized for infection management than patients without diabetes.

Hospitalization: Since 2006, nearly 6 million diabetics were annually hospitalized. 8–12% of these patients were hospitalized for infection management. In 2011, the inpatient care provided to patients with DM, and infection was responsible for over $48 billion dollars in aggregate hospital charges.

Conclusions

Diabetics commonly present to the emergency department and require hospitalization for infection management. The care provided to diabetics for infection management has a large economic impact on the United States healthcare system. More efforts are needed to develop cost-effective strategies for the prevention of infection in patients with diabetes.

Introduction

Diabetes mellitus (DM) is one of the most common systemic diseases worldwide. Currently, DM affects an estimated 366 million people. By 2030, it is estimated that over 550 million people will have DM—affecting more than 1 in 3 Americans (Centers for Disease Control and Prevention, 2011, International Diabetes Federation, 2011). In the United States, DM is the 7th leading cause of death and has been shown to be an independent risk factor for early death. DM is associated with multiple co-morbid conditions—including infection. Patients with type 1 and type 2 DM are at increased risk for infection secondary to poor glycemic control, diabetic neuropathy, and impaired innate and adaptive immune responses (Chen et al., 2009, Geerlings and Hoepelman, 1999, Valerius et al., 1982). Diabetics are at increased risk for community-acquired infections as well as rare infections like malignant otitis externa, rhinocerebral mucormycosis, and emphysematous pyelonephritis (Geerlings, 2008, Muller et al., 2005, Shah and Hux, 2003). Sepsis also occurs more frequently and has a higher mortality rate in patients with DM than in other individuals (Shah & Hux, 2003). In general, patients with diabetes are often more likely to develop recurrent infections or complications from infections that require inpatient hospital management (Joshi, Caputo, Weitekamp, & Karchmer, 1999).

The care provided to diabetics imposes a substantial burden on the United States healthcare system in the form of increased medical costs, chronic disability, and premature mortality. Medical costs for diabetics are ~ 2.3-fold higher than non-diabetic patients. Nearly half of the direct medical costs of diabetic care are believed to be associated with management of diabetic complications (Anonymous, 2014, Ward et al., 2014). In 2012, the American Diabetes Association (ADA) estimated that DM increased healthcare costs to $245 billion—a 41% increase from 2007 (Anonymous, 2014).

To date, the economic burden and resource allocation for common diabetic complications like infection are not well defined. Given the increasing prevalence of DM in the United States, there is a need to quantify the frequency in which diabetics seek care for infection and evaluate the associated costs and healthcare resource allocation. Thus, using the largest publically available all-payer emergency department (ED) and inpatient databases in the United States, we evaluate the number of diabetics requiring ED treatment or hospitalization for infection and estimate the financial impact associated for inpatient infection management in the presence of DM.