Impact of the COVID-19 pandemic on emergency department visits in adults with diabetes: findings from the national health interview survey

Abstract

Background: The COVID-19 pandemic affected healthcare utilization, particularly for populations with chronic disease. This study examined impact of the COVID-19 pandemic on Emergency Department (ED) visits among adults with diabetes in the U.S. Methods: We conducted a cross-sectional analysis of adults with diabetes using deidentified, publicly available data from the 2019-2021 National Health Interview Survey (NHIS). The primary independent variable was survey year: 2019 (pre-COVID-19 era) and 2020-2021 (COVID era). The outcome variable was any ED visit in the last 12 months. We conducted multivariable logistic regression to estimate the difference in ED visits before and during the COVID-19 pandemic among adults with diabetes. We estimated adjusted odds ratios and 95% confidence intervals adjusting for healthcare access, self-reported health status, demographic, and socioeconomic characteristics. Results: The sample consisted of 9,845 adults with diabetes (3,066 in 2019, 3,086 in 2020, and 2,899 in 2021). Of these, 19.5% were immigrants, 15.6% Non-Hispanic Black, 17.2% Hispanic, and 58.5% Non-Hispanic White. People with diabetes were 15% in 2020 [AOR 0.85 (95% CI 0.73-0.98)] and 24% in 2021 [AOR 0.76 (95% CI 0.65-0.88)] less likely to visit ED compared to 2019. Delayed care due to cost was significantly associated with increased odds (AOR 1.65; 95% CI 1.32, 2.06) of ED visits compared to those who did not delay their care due to cost. Having fair or poor health status was associated with higher odds of ED visits (AOR 2.01; 95% CI 1.68, 2.41) compared to those reporting excellent health status. Conclusion: Limited access to routine care during the COVID-19 pandemic for diabetes should have led to increased ED visits but the study found significant reduction in ED visits compared to pre-pandemic in people living with diabetes. Future studies are needed to examine whether the reductions in ER were derived from better telemedicine use or avoidance of using necessary care. Also, studies are needed for developing solutions that preserves healthcare delivery in public health care crisis.