(54) All-Cause Readmission Rates, In-Hospital Mortality, and Resource Use Outcomes for Patients with Type 1 Vs. Type 2 Diabetic Nephropathy in the United States

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1099

Presenting Author(s)

Koen Degeling, PhD, MSc
– Lumen Value & Access, Centre for Cancer Research and Centre for Health Policy, The University of Melbourne, Hengelo, Overijssel, Netherlands

Co-Author(s)

Rosa C. Banuelos
– Lumen Value and Access, University of North Carolina at Charlotte, Houston, Texas, United States
Evelyn Rizzo, MSc
– Research Scientist, Lumen Value and Access, IL, United States
Kathy Belk, BA
– Vice President, Lumen Value and Access, Mooresville, NC, United States

Background: Diabetic nephropathy (DN) is the chronic loss of kidney function and primary cause of end-stage renal disease in people with type 1 (T1) and type 2 (T2) diabetes mellites (DM).

Objectives: Determine 30-day readmission rates, in-hospital mortality and resource use outcomes among inpatient encounters with diagnosis of DN.

Methods: Cross-sectional analysis of Healthcare Cost and Utilization Project Nationwide Readmissions Database 2018. Sample weights were applied to generate nationally representative estimates for patients aged 18+ years old having diagnosis of T1DN or T2DN. Patients were excluded if the encounter included both T1DN and T2DN or if disposition at index was deceased. Demographics, comorbidities, length of stay (LOS), in-hospital mortality and cost-to-charge adjusted charges (costs) were stratified and compared using chi-square and t-tests.

Results: At index, 10,003 and 122,327 patients were identified as T1DN and T2DN, respectively. A total 261,957 (T1DN=24,359; T2DN=237,598) index events and 22,692 readmissions (T1DN=3,266; T2DN=19,426) were identified. 30-day readmission rates were higher in T2DN compared to T1DN (13.41% vs 8.18%, p <.0001). Readmitted patients were younger for T1DN at median (Q1-Q3) age of 40 (31-53) yrs. vs. T2DN at 66 (57-75) yrs. (p <.0001). More T1DN and T2DN were males (51.2%, 55.8%) vs. females (48.8%, 44.2%) at index (p <.0001). More T1DN readmissions were females (52.7%) (p <.0001). Medicare was primary payer for T2DN and T1DN at index (70.3%, 49.7%) and readmission (71.2%, 50.3%) (p < 0.0001). Greater mortality risk was observed at index and readmission among T2DN with median (Q1-Q3) CCI score of 6 (5-7) vs. 5 (4-6) for T1DN (p <.0001). Median (Q1-Q3) LOS was higher in T2DN at index [5(3-9) vs. 4(3-8) days, p<.0001] and for readmissions [5(3-9) vs. 5(3.8), p=.0026] vs. T1DN. Costs were higher for T2DN at index [$12,208 ($6,990-$23,183) vs. $11,189 ($6,299-$22,320), p<.0001] and at readmission [$12,269 ($7113-$22,378) vs. $11,070 ($6,479-$20,307), p<.0001] compared to T1DN. In-hospital mortality was more common among T2DN at index and readmission (3.0%, 4.3%) vs. T1DN (1.5%, 2.2%) (p <.0001).

Conclusions: A higher percentage of T1DN readmissions were younger and female. T2DM patients had higher in-hospital mortality, LOS and costs indicating greater disease.