Objectives: To evaluate the associations between potentially avoidable diabetes-related emergency/urgent hospital admissions and different health insurance status (ie, Medicaid, Medicare, uninsured, private), along with other characteristics including sociodemographic status (age, race/ethnicity, gender, region), hospitalization status (previous hospitalizations, weekend admissions), and health status (complications, comorbidities), among patients with type 2 diabetes mellitus (T2DM).
Study design: The 2011 data set of all inpatient discharge records with a primary diagnosis of T2DM from all hospitals in Pennsylvania were included in the analyses.
Methods: Multivariable logistic regression modeling with diabetes-related emergency/urgent hospitalizations as the dependent outcome variable and health insurance status as the main exposure independent variable, adjusting for age, race/ethnicity, gender, region, previous hospitalizations, weekend admissions, complications, and comorbidity. Hosmer and Lemeshow goodness-of-fit test was used for logistic model fit analysis.
Results: Nearly 91% of 17,097 potentially avoidable diabetes-related hospitalizations were emergency/urgent admissions for T2DM patients in Pennsylvania during 2011. Uninsured and Medicaidinsured patients were 2.1 (adjusted odds ratio [AOR], 2.11; 95% CI, 1.23-3.61) and 1.8 (AOR, 1.78; 95% CI, 1.44-2.20) times more likely than privately insured patients, respectively, to be admitted through emergency/urgent admissions. There was no statistically significant difference in emergency/urgent admissions between Medicaid and uninsured (AOR, 0.85; 95% CI, 0.49-1.47).
Conclusions: Medicaid-insured T2DM patients, like the uninsured, are more likely to be hospitalized through emergency/urgent admissions. The presumption that insured individuals with diabetes are more likely than the uninsured to manage and control the progression of their condition, and receive care in the right setting, is not supported for those with Medicaid coverage.