Common reasons for hospitalization in urban diabetes patients

Objectives: Determine principal reasons for hospitalization in a predominantly urban, African American diabetes patient population. Design: Data for outpatients with a diagnosis of diabetes were abstracted from electronic records. The number of hospitalizations from 1998 through 2001 was determined after linking our dataset with a statewide discharge dataset. Principal diagnoses were grouped into 18 multilevel diagnostic classes using the Agency for Healthcare Research and Quality's Clinical Classifications Software. Patients: A total of 6505 unique patients had 20,344 discharges from 1998 through 2001; 92% were listed as African Americans and 61% as women. Main Outcome Measures: Frequency of each multilevel diagnostic class and the most commonly occurring diagnoses. Results: The most common multilevel diagnostic classes were "diseases of the circulatory system" (29.0% of all discharges) and "endocrine, nutritional, and metabolic; immunity disorders" (17.1%). The five most commonly occurring unique diagnoses were "congestive heart failure," "diabetes with ketoacidosis or uncontrolled diabetes," "coronary atherosclerosis," "diabetes with other manifestations," and "pneumonia, organism unspecified." Nearly 16% of all discharged patients had diagnoses related to infection. The five most frequent diagnoses related to infection were "pneumonia, organism unspecified," "urinary tract infection, site not specified," "infection and inflammation, internal prosthetic device," "cellulitis and abscess of leg," and "postoperative infection." Conclusions: In this predominantly urban, African American diabetes patient population, potentially preventable hospitalizations involving diseases such as congestive heart failure and diabetes occur with high frequency. Better understanding of the risk factors underlying these hospitalizations - particularly those involving modifiable metabolic variables - requires further investigation.