NCHS Data Brief ■ No. 301 ■ February 2018

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Emergency Department Visits by Patients Aged 45 and Over 

With Diabetes: United States, 2015

Margaret J. Hall, Ph.D., Pinyao Rui, M.P.H., and Alexander Schwartzman

Key findings 

Data from the National 

Hospital Ambulatory 

Medical Care Survey

● In 2015, there were an

estimated 12 million emergency

department (ED) visits by

patients aged 45 and over with

diabetes, a rate of 92 per 1,000

persons aged 45 and over.

● The percentage of all ED

visits for patients aged 45

and over made by those with

diabetes increased from 2012

to 2015.

● The diabetes ED visit rate

was about 2.5 times higher for

those aged 75 and over than the

rate for those aged 45–64.

● Twenty-four percent of the

diabetes ED visits for those

aged 45–64 had Medicare as

the primary expected payment

source, compared with 14% of

the ED visits for patients aged

45–64 without diabetes.

● Twenty-two percent of the

diabetes ED visits for those

aged 45–64 ended in hospital

admission compared with 12%

of the visits by patients without

diabetes in that age group.

An estimated 30 million Americans have diabetes, of whom 26 million 

are aged 45 and over (1). Healthy eating and exercise can prevent diabetes 

progression (1,2). Around 12 million emergency department (ED) visits in 

2015 were by patients aged 45 and over with diabetes, representing 24% of ED 

visits by patients aged 45 and over and 80% of diabetes ED visits by patients 

of all ages (3). This report presents data on ED visits by patients aged 45 and 

over with diabetes, defined as visits for which diabetes is mentioned as either a 

diagnosis or as one of a set of conditions that the patient is reported to have.

Keywords: expected source of payment • NHAMCS

Did the percentage of all ED visits for patients aged 45 and 

over with diabetes change from 2010 to 2015?

● In 2015, about 24% of all ED visits for patients aged 45 and over were

made by those with diabetes (Figure 1).

Figure 1. Percentage of all emergency department visits for patients aged 45 years and older 

made by those with diabetes, by age and year: United States, 2010–2015

1

Increase from 2012 to 2015 is significant (p < 0.05). 2

Increase from 2010 to 2015 is significant (p < 0.05). 3

Increase from 2013 to 2015 is significant (p < 0.05).

NOTES: To be counted as an emergency department visit by a patient with diabetes, the medical record had to contain 

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) code 249 or 250 in at least one of the 

diagnostic fields, or have an indication elsewhere in the medical record that the patient had diabetes. Access data table for 

Figure 1 at: https://www.cdc.gov/nchs/data/databriefs/db301_table.pdf#1.

SOURCE: NCHS, National Hospital Ambulatory Medical Care Survey, 2010–2015.

75 and over3

65–742

45–641

45 and over1

35

30

20

10

2010 2011 2012 2013 2014 2015

25

15

5

0
NCHS Data Brief ■ No. 301 ■ February 2018

■ 2  ■

● The percentage of all ED visits for patients aged 45 and over made by those with diabetes

increased from 2012–2015.

● In 2015, the percentage of all ED visits made by patients with diabetes was higher for

patients aged 65 and over compared with patients aged 45–64 (32% for 65–74 and 27% for

75 and over compared with 20% for 45–64).

Did the rate of emergency department visits by patients aged 45 and over 

with diabetes increase with age?

● The rate of diabetes ED visits for patients aged 45 and over increased with age (Figure 2).

● The rate ranged from 69 per 1,000 persons for those aged 45–64 to 164 per 1,000 persons

for those aged 75 and over.

Figure 2. Rate of emergency department visits by patients aged 45 and over with diabetes, by age: United States, 2015

1

Linear increase across all age groups (p < 0.05).

NOTES: ED is emergency department. To be counted as an ED visit by a patient with diabetes, the medical record had to contain International Classification of 

Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) code 249 or 250 in at least one of the diagnostic fields, or have an indication elsewhere in the medical 

record that the patient had diabetes. Visit rates are based on estimates of the civilian noninstitutionalized U.S. population as reported by the 

U.S. Census Bureau, Population Division. Access data table for Figure 2 at: https://www.cdc.gov/nchs/data/databriefs/db301_table.pdf#2.

SOURCE: NCHS, National Hospital Ambulatory Medical Care Survey, 2015.

ED visits per 1,000 persons

Age group (years)

45 and over

45–641

75 and over

65–74

0 4 20 0 60 80 100 120 140 160 180

164

114

69

92
■ 3  ■

Did the primary expected source of payment for ED visits made by patients 

aged 45 and over differ for patients with and without diabetes?

● A higher percentage of ED visits for patients aged 45–64 with diabetes had Medicare as

their primary expected source of payment (24%) compared to non-diabetes ED visits (14%)

(Figure 3).

● A lower percentage of ED visits for patients aged 45–64 with diabetes had private insurance

(32%) as their primary expected source of payment compared to non-diabetes visits (38%).

● Seventy-seven percent of ED visits made by those aged 65 and over with diabetes and 78%

made by those without diabetes had Medicare as the primary expected payment source.

● Nine percent of ED visits made by those aged 65 and over had private insurance as the

expected source of payment for those with and without diabetes.

Figure 3. Distribution of primary expected source of payment for emergency department visits made by those aged 45–64 

and 65 and over, by diabetes status: United States, 2015

1

Percentage of visits for those aged 45–64 with a primary expected source of payment of private insurance was significantly lower for those with diabetes than for 

those without diabetes (p < 0.05). 2

Percentage of visits for those aged 45–64 with a primary expected source of payment of Medicare was significantly higher for those with diabetes than for those 

without diabetes (p < 0.05).

NOTES: ED is emergency department. To be counted as an ED visit by a patient with diabetes, the medical record had to contain International Classification of 

Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) code 249 or 250 in at least one of the diagnostic fields, or have an indication elsewhere in the medical 

record that the patient had diabetes. CHIP is Children's Health Insurance Program. Uninsured includes self-pay and no charge or charity. Other/unknown includes 

worker's compensation, other payment source, unknown, and blank. Percentages may not always add to 100 due to rounding. Access data table for Figure 3 at: 

https://www.cdc.gov/nchs/data/databriefs/db301_table.pdf#3.

SOURCE: NCHS, National Hospital Ambulatory Medical Care Survey, 2015.

Other/

unknown

Medicaid/CHIP or Uninsured

state-based program

Private insurance Medicare

45–64 65 and over

60

20

With diabetes Without diabetes With diabetes Without diabetes

Percent of ED visits

80

40

0

1

32

2

24

27

8 8

38

14

22

10

16

9

77

5

1

8 9

78

4

1

9
NCHS Data Brief ■ No. 301 ■ February 2018

■ 4  ■

For patients aged 45–64 and 65 and over, did a higher percentage of 

diabetes-related ED visits end in inpatient hospital admission than for nondiabetes ED visits?

● For all patients aged 45 and over, 28% of the diabetes ED visits ended in inpatient hospital

admission, which was higher than the 17% of visits by patients without diabetes (Figure 4).

● For patients aged 45–64, 22% of the diabetes ED visits ended in inpatient hospital

admission, which was higher than the 12% of visits by patients without diabetes.

● For patients aged 65 and over, 34% of the diabetes ED visits ended in inpatient hospital

admission, which was higher than the 26% of visits by patients without diabetes.

● For aged 65 and over, patients with and without diabetes, the percentage of ED visits that

ended in inpatient hospital admission was higher than the percentage of visits for those aged

45–64.

Figure 4. Percentage of emergency department visits made by patients aged 45 and over that resulted in a hospital 

admission, by diabetes status: United States, 2015

1

The percentage of visits for patients aged 45 and over, 45–64, and 65 and over with diabetes that ended in inpatient hospital admission was significantly higher 

than the percentage of visits for those in these age groups without diabetes with this discharge disposition. 

2

Those aged 65 and over regardless of diabetes status had a significantly higher percentage of visits ending in hospitalization than those aged 45–64. 

NOTES: To be counted as an emergency department (ED) visit by a patient with diabetes, the medical record had to contain International Classification of 

Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) code 249 or 250 in at least one of the diagnostic fields, or have an indication elsewhere in the medical 

record that the patient had diabetes. Hospital admission includes those ED visits where patients were admitted as an inpatient to the same hospital, and those 

visits after which the patient was transferred to another nonpsychiatric hospital. Access data table for Figure 4 at: 

https://www.cdc.gov/nchs/data/databriefs/db301_table.pdf#4. 

SOURCE: NCHS, National Hospital Ambulatory Medical Care Survey, 2015. Percent

Admitted

Not

admitted

With

diabetes1

Without

diabetes

45–64

22

78

12

88

With

diabetes1

Without

diabetes

65 and over2

34

66

26

74

With

diabetes1

Without

diabetes

45 and over

28

72

17

83

100

80

60

40

20

0
■ 5  ■

NCHS Data Brief ■ No. 301 ■ February 2018

Summary

This analysis of the National Hospital Ambulatory Medical Care Survey data shows that in 2015, 

12 million ED visits were made by patients aged 45 and over with diabetes, accounting for around 

one-quarter of all ED visits by patients aged 45 and over. The diabetes ED visit rate was 92 per 

1,000 persons for patients aged 45 and over, which was about 6 times higher than the diabetes 

ED visit rate for those under age 45 (16 per 1,000 persons). The percentage of all ED visits made 

by patients aged 45 and over with diabetes was highest for those aged 65–74, followed by 75 

and over, and then by those aged 45–64 in all years from 2010 to 2015. The percentage of all 

ED visits made by patients with diabetes increased from 2010 to 2015, with the largest increases 

occurring from 2013–2015 in all age groups. The diabetes ED visit rate for those 75 and over 

was more than twice the rate for those aged 45–64. About one-quarter of the diabetes ED visits 

for those aged 45–64 had Medicare as the primary expected source of payment compared to 14% 

of visits for patients aged 45–64 without diabetes. A higher percentage of diabetes ED visits for 

those aged 45 and over ended in hospital admission (28%) than non-diabetes ED visits (17%).

Definitions

ED visits by patients aged 45 and over with diabetes, also referred to as diabetes ED visits: Since 

2009, the National Hospital Ambulatory Medical Care Survey (NHAMCS) has asked, “Does the 

patient have (mark all that apply): cerebrovascular disease/history of stroke, congestive heart 

failure, condition requiring dialysis, HIV, diabetes, or none of the above?” This item has since 

changed to include additional chronic conditions. To be sure that the checkboxes are all-inclusive, 

during the data editing process, a consistency check is performed to be sure that any record 

with a visit diagnosis of any of the above chronic conditions, including diabetes, also has the 

checkbox marked. This report includes emergency department visits, made by patients aged 45 

and over, which have documentation of diabetes (ICD–9–CM [4] diagnostic code 249 or 250) in 

their medical record, or which have diabetes indicated elsewhere in the patient’s medical record. 

Managing diabetes is the reason for some of these visits, but many other reasons, such as chest 

pain or an injury, are also included.

Primary expected source of payment for this visit: Private insurance: Charges paid in part or in 

full by a private insurer (e.g., BlueCross BlueShield), either directly to the hospital or reimbursed 

to the patient. Charges covered under a private insurance-sponsored prepaid plan are included.

Medicare: Charges are paid in part or in full by a Medicare plan. Includes payments made directly 

to the hospital as well as payments reimbursed to the patient. Charges covered under a Medicaresponsored prepaid plan are included. 

Medicaid: Charges paid in part or in full by a Medicaid plan. Includes payments made directly to 

the hospital or reimbursed to the patients. Charges covered under a Medicaid-sponsored prepaid 

plan or the Children’s Health Insurance Program (CHIP) are included. 

No insurance: Includes self-pay and no charge or charity. Self-pay includes charges that are paid 

by the patient or patient’s family, which will not be reimbursed by a third party. Self-pay includes 

visits for which the patient is expected to be ultimately responsible for most of the bill, even if 

the patient never actually pays it. This does not include copayments or deductibles. No charge 

or charity is the category for visits for which no fee is charged (e.g. charity, special research, or 
NCHS Data Brief ■ No. 301 ■ February 2018

■  6  ■

teaching). No charge or charity does not include visits paid for as part of a total package (e.g., 

prepaid plan visits, postoperative visits included in a surgical fee, and pregnancy visits included 

in a flat fee charged for the entire pregnancy).

Other/unknown: Includes worker’s compensation, other payment source, unknown, and blank. 

If more than one expected source of payment was reported, the primary source was determined 

using the following hierarchy: Medicare, Medicaid or Children’s Health Insurance Program 

(CHIP), private insurance, worker’s compensation, self-pay, no charge/charity, other, and 

unknown.

Data source and methods

ED visit data are from the 2015 NHAMCS, a nationally representative survey of nonfederal 

general and short-stay hospitals that is conducted by the National Center for Health Statistics. 

NHAMCS uses a multistage probability design with samples of geographic primary sampling 

units (PSUs), hospitals within PSUs, and patient visits within EDs. In 2015, 243 hospitals 

reported emergency department data in NHAMCS, and data were collected on approximately 

21,000 ED visits. Additional information on the methodology of NHAMCS is available online 

(5), as is the public-use data file (3). In addition to 2015 data, the trend data for Figure 1 were 

from the 2010 through 2015 NHAMCS surveys.

Data analysis was performed using the statistical packages SAS version 9.4 (SAS Institute, Cary, 

N.C.) and SAS-callable SUDAAN version 11.0 (RTI International, Research Triangle Park, 

N.C.). Differences among subgroups were evaluated using a two-tailed t test (p < 0.05). To test 

for linear and quadratic trends over time, the null hypothesis of nonlinear or quadratic trend was 

examined using the POLY option in SUDAAN. Statistical tests of trends for Figures 1 and 2 were 

performed using logistic regression.
■ 7  ■

About the authors

Margaret J. Hall and Alexander Schwartzman are with the National Center for Health Statistics, 

Division of Health Care Statistics. Pinyao Rui is with Karna, LLC.

References

1. CDC. National Diabetes Statistics Report, 2017. Atlanta, GA. 2017.

2. Garcia-Perez L E, Álvarez M, Dilla T, Gil-Guillén V, Orozco-Beltrán D. Adherence to

therapies in patients with type 2 diabetes. Diabetes Ther 4(2):175–94. 2013.

3. National Center for Health Statistics. 2015 NHAMCS micro-data set file. Hyattsville, MD.

2017. Available from: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Datasets/NHAMCS/

ED2015.zip.

4. CDC, Centers for Medicare & Medicaid Services. International classification of diseases,

ninth revision, clinical modification. 6th ed. DHHS Pub No. (PHS) 11–1260. 2011.

5. National Center for Health Statistics. 2015 NHAMCS micro-data file documentation.

Hyattsville, MD. 2017. Available from: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/

Dataset_Documentation/NHAMCS/doc15_ed.pdf. 
NCHS Data Brief ■ No. 301 ■ February 2018

Suggested citation

Hall MJ, Rui P, Schwartzman A. Emergency 

department visits by patients aged 45 and 

over with diabetes: United States, 2015. 

NCHS Data Brief, no 301. Hyattsville, MD: 

National Center for Health Statistics. 2017.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

Denys T. Lau, Ph.D., Acting Director

Alexander Strashny, Ph.D., Associate 

Director for Science

For e-mail updates on NCHS publication 

releases, subscribe online at: 

https://www.cdc.gov/nchs/govdelivery.htm.

For questions or general information

about NCHS:

Tel: 1–800–CDC–INFO (1–800–232–4636)

TTY: 1–888–232–6348

Internet: https://www.cdc.gov/nchs

Online request form: https://www.cdc.gov/info

ISSN 1941–4927 Print ed.

ISSN 1941–4935 Online ed.

DHHS Publication No. 2018–1209

CS289064

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road, Room 4551, MS P08

Hyattsville, MD 20782–2064

OFFICIAL BUSINESS 

PENALTY FOR PRIVATE USE, $300

For more NCHS Data Briefs, visit: 

https://www.cdc.gov/nchs/products/databriefs.htm.

FIRST CLASS MAIL 

POSTAGE & FEES PAID 

CDC/NCHS

PERMIT NO. G-284