More youth with diabetes hospitalized, costing billions

Obesity is taking a hefty toll on the health of children and young adults, leaving more Americans facing the burden of a lifetime of diabetes care and management.

This trend also is leading to significant increases in hospitalizations among young adults with diabetes - and that's costing Medicaid and private insurers billions each year in hospital fees, according to researchers at University of Michigan C.S. Mott Children's Hospital.

A new study - published in the December issue of Diabetes Care - finds that the number of children and young adults with diabetes who were hospitalized from 1993 to 2004 increased 38 percent. During that period, hospital charges for diabetes care for children and young adults also swelled, from $1.05 billion in 1993 to $2.42 billion in 2004. Plus, researchers say, rates of hospitalization were higher among young women with diabetes than for young men.

Lead study author Joyce Lee, M.D., MPH, a pediatric endocrinologist and member of the Child Health Evaluation and Research (CHEAR) Unit in the U-M Division of General Pediatrics, says these findings reflect the recent epidemic of childhood obesity and the increasing burden of diabetes among young adults.

"The number of young adults hospitalized with diabetes in the U.S. has increased significantly over the past decade, along with the rate of childhood obesity," says Lee. "Today's young adults experienced childhood and adolescence in the leading edge of the childhood obesity epidemic in the 1970s and 1980s. Our findings suggest that we may now just be beginning to see the first manifestation of a related 'diabetes epidemic' among these young adults."

For the study, Lee and her colleagues used the Nationwide Inpatient Sample - a nationally representative annual sample of discharges from nonfederal, short-term, general and other specialty hospitals in the U.S. - to access trends from 1993 to 2004 in hospitalizations associated with a diabetes diagnosis.

While the data showed a considerable increase in hospitalization rates among young adults, ages 20 to 29, it did not find significant growth for hospitalizations among children younger than 20.

The study also revealed a great divide among the sexes. Even after removing hospitalizations associated with childbirth, increases in rates of hospitalization were significantly higher during the 12-year period for females (42 percent) compared with males (29 percent).

Most notably, the study reported a rapid growth in health care expenditures as the result of diabetes-related hospitalizations. In 2004 alone, hospital charges were estimated to be $924 million for Medicaid, and $849 million for private payers.

"With the growing epidemic of childhood obesity and increasing trends in type 2 diabetes among young adults, the economic burden of diabetes will only continue to rise, affecting public and private insurance plans alike," says Lee, assistant professor in the Department of Pediatrics and Communicable Diseases at the U-M Medical School

Lee says this study points to the need for further research to examine trends in diabetes prevalence among young adults, as well as how the U.S. childhood obesity epidemic may further amplify such trends in health care. Those trends - and their associated costs - also "may provide third-party payers with a strong impetus to cover more services focused on disease prevention and the treatment of childhood obesity," she says.

In addition to Lee, co-authors are: from the University of California, San Francisco: Megumi J. Okumura, M.D.; and from the University of Michigan C.S. Mott Children's Hospital: Gary L. Freed, M.D., MPH, Percy and Mary Murphy Professor of Pediatrics and Child Health Delivery, and chief of the Division of General Pediatrics; Ram K. Menon, M.D., professor, Department of Pediatrics and Communicable Diseases, and director of Pediatric Endocrinology; and Matthew M. Davis, M.D., M.A.P.P., associate professor of general pediatrics and internal medicine, and associate professor of public policy at the Gerald R. Ford School of Public Policy.

This study was supported by the National Institutes of Health (National Institute of Child Health and Human Development) Pediatric HSR Training Grant, and the Clinical Sciences Scholars Program. The biostatistics core of the Michigan Diabetes Research and Training Center was funded by the National Institute of Diabetes and Digestive and Kidney Diseases Grant.

Reference: Diabetes Care, December 2007, Vol. 30, No. 12.