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Ambulatory care-sensitive hospitalisations
Complications related to diabetes and its management including hypo- or hyperglycaemia can require hospital treatment. This indicator has been established on an international level and is published by OECD statistics every two years as part of an international comparison of the quality of ambulatory care (OECD, 2023). Following OECD guidelines, only hospitalisations with diabetes as the main diagnosis are considered. While inpatient hospitalisations with diabetes as a secondary diagnosis are not taken into account, these make up a large number of hospitalisations due to the fact that diabetes prevalence increases with age (Lehmann et al., 2019).
Key messages
- In 2021 and 2022, the rate of ambulatory care-sensitive hospitalisations due to diabetes stagnated at 203 and 205 cases per 100,000 residents respectively, after a sharp decline at the start of the COVID-19 pandemic in 2020.
- The rate of ambulatory care-sensitive hospitalisations is particularly high in the federal states with high diabetes prevalence and regions with high socioeconomic deprivation.
trend
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cross-section
By state
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By gender
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By age
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By regional socioeconomical deprivation
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Results
Between 2015 and 2019, rates of hospitalisation with diabetes as the main diagnosis per 100,000 residents is relatively constant with a slight decrease. Subsequently, the rate drops sharply from 248 per 100,000 residents in 2019 to 207 in 2020 and stagnated at that level in 2021 and 2022 with 203 and 205 respectively. For women, the rate is 150 and for men 262 per 100,000 residents in 2022. The decline during the COVID-19 pandemic is also evident in all federal states. In 2022, higher rates were recorded notably in Mecklenburg-Western Pomerania (241 for women; 412 for men per 100,000 residents) than in Hamburg, the state with the lowest rate (women: 101; men: 204). For both women and men, the highest rates of ambulatory care-sensitive hospitalisations due to diabetes are found in regions with high socioeconomic deprivation.
Conclusion
Between 2015 and 2019, the rate of ambulatory care-sensitive hospitalisations due to the indication diabetes decreases slightly. In 2020, there is a sharp decline, which must be interpreted in the context of the COVID-19 pandemic. An analysis by the Leibniz Institute for Economic Research (RWI) shows a sharp decline in all outpatient-sensitive hospital cases - also due to diabetes - from the beginning of the pandemic in March 2020 ("Leistungsgeschehen von Krankenhäusern in der Corona-Krise"; in German only). The hospital report 2023 confirms the finding that after the sharp drop of ambulatory care-sensitive hospital cases with the start of the pandemic these stay at a lower level. A change in behaviour regarding the utilization of health care services is assumed. Overall, women show significantly lower rates compared to men. Regional differences persist in 2022, and the highest rates for ambulatory care-sensitive hospital cases are observed in the federal states with already high prevalence of diabetes. Regions with high socioeconomic deprivation are also associated with higher diabetes prevalence (Grundmann et al. 2014), which contributes to the higher rates of ambulatory care-sensitive hospital cases in these regions. The present analysis does not include rates of hospitalisation for patients with diabetes as a secondary diagnosis.