Health Care Utilization Trends Across the Transition Period in a National Cohort of Adolescents and Young Adults With Type 1 Diabetes

Abstract

Objective: Lack of effective transition from pediatric to adult care may contribute to adverse outcomes in young adults with type 1 diabetes. The understanding of outpatient and acute care utilization patterns across the adolescent to young adult transition age in type 1 diabetes populations is suboptimal in the U.S.

Research design and methods: We studied claims data from 14,616 individuals diagnosed with type 1 diabetes, aged 16-24 years, and enrolled in a large national health plan for ≥1 year from 2005 to 2012. Annual outpatient and emergency department visits and hospitalization rates were calculated at each age. Generalized estimating equations were used to assess the association of age-group (adolescents [age 16-18 years] vs. young adults [age 19-24 years]), outpatient visits, and sociodemographic variables with emergency department visit and hospitalization rates.

Results: Endocrinologist visits declined from 2.3 per year at age 16 years to 1.5 per year by age 22. Emergency department rates increased per year from 45 per 100 at age 16 to 63 per 100 at age 20, then decreased to 60 per 100 by age 24. Hospitalizations per year climbed from 14 per 100 at age 16 to 21 per 100 at age 19, then decreased to 17 per 100 by age 24. In statistical models, young adults experienced higher rates of emergency department visits (incidence rate ratio [IRR] 1.24 [95% CI 1.18, 1.31]) and hospitalizations (IRR 1.25 [95% CI 1.15, 1.36]) than adolescents. Additional significant predictors of emergency department visits and hospitalizations included female sex and Black race. Individuals with two or more endocrinologist visits per year were less likely to have emergency department visits and hospitalizations; higher income was also protective.

Conclusions: Results highlight concerning increases in acute care utilization for young adults with type 1 diabetes who are less engaged with outpatient diabetes care and highlight socioeconomic risk factors that warrant further study.

Figure 1

Outpatient visit trends by age. A: Trends broken down by pediatric endocrinology, pediatric primary care, adult endocrinology, and adult primary care and internal medicine visits. B: Trends broken down by adult plus pediatric endocrinology and adult plus pediatric primary care visits. Depicted are marginal rates (visits per year) by age for outpatient visits, with adjustment for sex, U.S. region, ACG morbidity score, race/ethnicity, and neighborhood income/education.

Figure 2

Overall emergency department (ED) visits and nonobstetric (non-OB) hospitalizations by age. Depicted are marginal adjusted rates (visits per 100 per year) by age for ED visits and non-OB hospitalizations, with adjustment for sex, U.S. region, ACG morbidity score, race/ethnicity, and neighborhood income/education.