Trend of Diabetes-Related Hospital Admissions During the Transition Period From Adolescence to Adulthood in the State of California.

Abstract

This study examined the incidence of diabetes-related hospital admissions and described the characteristics among youth and emerging adults with type 1 (T1D) and type 2 diabetes (T2D) in California. A retrospective study was conducted using the statewide inpatient database during the years 2014-2018. Individuals aged 13-24 years hospitalized with diabetic ketoacidosis (DKA) or severe hypoglycemia (SH) were recorded. Demographic characteristics and health measures among youth (ages 13-18) and young adults (ages 19-24) were compared. A total of 34,749 admission encounters for T1D and 3,304 for T2D were analyzed. Hospitalization rates significantly increased with age during the transition to adulthood, from 70/100,000 California population at age 17 to 132/100,000 at age 19 in T1D. Higher hospitalization rates were demonstrated in young adults than in youth in T1D, and the rate was significantly higher in Black young adults (23.9%) than in youth (12.0%) among the age-adjusted population with diabetes (P < 0.0001). More young adults admitted were on public insurance, and approximately half were from the lowest income quartile. No difference was observed in hospital length of stay; however, hospital charges were higher among young adults. Young adults were three times more likely to be admitted for severe conditions. We demonstrated a significant rise in hospital admission during the transition period in individuals with T1D. There were significantly more Black young adults who were on public insurance and had lower socioeconomic status. Our findings suggest that the health care system fails many emerging adults with diabetes, particularly for people of color, and that improving medical transition is crucial.