Data & Trends

Diabetes Surveillance System

1999 Surveillance Report

Chapter 1: The Public Health Burden of Diabetes Mellitus in the United States

Use of Health Care Services

The use of health care services by persons with diabetes is high (17,18), and a large proportion of the cost of diabetes has been attributed to inpatient hospital care (2). As the number of persons with diabetes increases, the total amount of health care services used by persons with diabetes also will increase.

Inpatient hospital care
In 1996, there were 503,000 hospital discharges with diabetes as the first-listed diagnosis (Figure 4.1, Table 4.3) and 3.8 million discharges listing diabetes as one of seven discharge diagnoses (i.e., any listed diagnosis) (Figure 4.2, Table 4.5). Diabetes as any listed diagnosis accounted for 25.1 million days of hospital stay in 1996.

Between 1980 and 1996, the average length of stay for hospital discharges with diabetes as the first-listed diagnosis and for diabetes as any listed diagnosis decreased by about 40% (Tables 4.3 and 4.5). Decreases in average length of stay were seen among all age and race-sex groups examined (Figures 4.3 and 4.4, Tables 4.3, 4.4, 4.5, 4.6).

Among persons with diabetes, age-adjusted hospital discharge rates with diabetes as the first-listed diagnosis decreased 47% between 1980 and 1996, with most of the decrease occurring in 1984 and 1985, following the implementation of Medicare’s prospective payment system in 1983 (Figure 4.8, Table 4.21). Although discharge rates declined for both whites and blacks, hospital discharge rates with diabetes as the first-listed diagnosis were higher among blacks throughout the time period (Figure 4.11, Tables 4.24 and 4.27). Also throughout the time period, rates were highest among persons aged <45 years (Figure 4.10, Table 4.21). This age group also had the lowest rate of decrease between 1980 and 1996 (a 35% decrease for those aged <45 years vs. -50% decrease among older age groups).

Although hospital discharge rates with diabetes as the first-listed diagnosis were highest among persons aged <45 years, rates of hospital discharge with diabetes as any listed diagnosis per 1,000 diabetic population were higher among older age groups (Figure 4.12, Table 4.28). Also, in contrast to the trends in the discharge rates based on diabetes as the primary diagnosis, trends in the age-adjusted rates of diabetes-related discharges were less clear and showed little change in this time period (Figure 4.9, Table 4.28).

Physician contacts
In 1996, persons with diabetes reported that they made almost 143 million contacts with physicians (Figure 4.14, Table 4.35), averaging 17.4 age-adjusted contacts per person (Figure 4.15, Table 4.38). About 45% of these contacts (64 million) were office visits to physicians and averaged 7.9 visits per person (Figures 4.16 and 4.17, Tables 4.41 and 4.44). The age-adjusted average number of physician contacts and physician office visits per person were higher among women (18.8 contacts and 8.5 visits) than among men (15.6 contacts and 7.0 visits) (Figure 4.18, Tables 4.39, 4.40, 4.45, and 4.46). Between 1980 and 1996, the age-adjusted number of physician contacts and office visits per person increased at a greater rate among women (relative increase of 49% in contacts and 25% in office visits) than among men (relative increase of 19% in contacts and 17% in office visits).

In 1996, physicians reported diabetes as one of three diagnoses recorded in a total of 28 million office-based visits by ambulatory patients (Figure 4.19, Table 4.47). Persons with diabetes averaged 3.4 ambulatory, office-based visits per person (Figure 4.20, Table 4.47).

Emergency room visits
In 1996, diabetes was recorded as one of three diagnoses for 1.2 million emergency room visits (Table 4.50). About 14% of persons with diabetes had a diabetes-related emergency room visit (Table 4.50), and the highest rate of visit was among persons aged <45 years, who had about twice the rates of the two older age groups (Figure 4.21).

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This page last reviewed January 18, 2005.

United States Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation