Age Disparities Among Patients With Type 2 Diabetes and Associated Rates of Hospital Use and Diabetic Complications

David C. Lee, MD, MS; Ta'Loria Young; Christian A. Koziatek, MD; Christopher J. Shim, JD, MS; Marcela Osorio; Andrew J. Vinson, MA; Joseph E. Ravenell, MD, MS; Stephen P. Wall, MD, MSc, MAEd

Disclosures

Prev Chronic Dis. 2019;16(8):e101 

In This Article

Abstract and Introduction

Abstract

Introduction: Although screening for diabetes is recommended at age 45, some populations may be at greater risk at earlier ages. Our objective was to quantify age disparities among patients with type 2 diabetes in New York City.

Methods: Using all-payer hospital claims data for New York City, we performed a cross-sectional analysis of patients with type 2 diabetes identified from emergency department visits during the 5-year period 2011–2015. We estimated type 2 diabetes prevalence at each year of life, the age distribution of patients stratified by decade, and the average age of patients by sex, race/ethnicity, and geographic location.

Results: We identified 576,306 unique patients with type 2 diabetes. These patients represented more than half of all people with type 2 diabetes in New York City. Patients in racial/ethnic minority groups were on average 5.5 to 8.4 years younger than non-Hispanic white patients. At age 45, type 2 diabetes prevalence was 10.9% among non-Hispanic black patients and 5.2% among non-Hispanic white patients. In our geospatial analyses, patients with type 2 diabetes were on average 6 years younger in hotspots of diabetes-related emergency department use and inpatient hospitalizations. The average age of patients with type 2 diabetes was also 1 to 2 years younger in hotspots of microvascular diabetic complications.

Conclusion: We identified profound age disparities among patients with type 2 diabetes in racial/ethnic minority groups and in neighborhoods with poor health outcomes. The younger age of these patients may be due to earlier onset of diabetes and/or earlier death from diabetic complications. Our findings demonstrate the need for geographically targeted interventions that promote earlier diagnosis and better glycemic control.

Introduction

Poor glycemic control, microvascular diabetic complications, and frequent diabetes-related hospital use have been shown to cluster in the same neighborhoods.[1,2] Therefore, certain communities have poorer health outcomes, higher morbidity and mortality, and a higher proportion of the financial burden associated with diabetes. Many of these areas have a higher proportion of racial/ethnic minority residents, including non-Hispanic black and Hispanic residents.[3] Their higher burden of diabetes is attributable in part to socioeconomic status, environmental influences, and health behaviors.[4–7]

Diabetes prevention before onset and optimal management after diagnosis are critical to reduce these disparities.[8,9] The American Diabetes Association recommends screening for type 2 diabetes starting at age 45.[10] The guidelines also suggest that earlier screening of persons at high risk may be warranted as a part of ongoing medical care.[11] These recommendations are complicated in clinical practice because many people who are at high risk for diabetes also have limited access to medical care. In these populations, diagnosis may be delayed, which may have important implications for the development of long-term diabetic complications and early diabetes-related death.[12]

The objective of this study was to investigate the age distribution of patients with type 2 diabetes in light of American Diabetes Association screening recommendations at age 45. Previous studies showed that claims data can be used to estimate the prevalence of diabetes and its associated complications and that claims data compare favorably with traditional health survey estimates.[2,13] These studies demonstrated that the demographic distribution of unique emergency patients is similar to the demographic distribution of census estimates of the general population and is thus useful for tracking diabetes cross-sectionally for a large proportion of the population in a given geographic area.[2]

In this study, we used all-payer claims data to analyze the age of patients with type 2 diabetes in New York City and to stratify patients by sex, race, and ethnicity. We also examined the average age of patients with type 2 diabetes living in previously identified "hotspots" (ie, geospatial clusters) of diabetes-related hospital use. These rates of hospital use are important because diabetes-related emergency department visits and inpatient hospitalizations account for nearly half of the large financial burden associated with diabetes.[14] We also analyzed the average age of patients with type 2 diabetes in previously identified hotspots of macrovascular (eg, myocardial infarction and stroke) versus microvascular (eg, end-stage renal disease and non-traumatic lower extremity amputations) diabetic complications because they have significant consequences for patient outcomes.[15]

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