Incident Diabetes Diagnosis Among the Uninsured During COVID-19 Hospitalization

Undiagnosed diabetes is associated with lack of insurance, which decreases access to preventive care. During the COVID-19 pandemic, uninsured patients previously unknown to health systems were hospitalized.

This is a cross-sectional analysis of electronic health record data from patients with diabetes hospitalized with COVID-19 in a safety-net health system from June 2020 to December 2021, examining the association between payor status and incident diagnosis of diabetes. Incident diagnosis of diabetes was defined by excluding a prior known diagnosis of diabetes based on diagnosis codes, medications, and HgbA1c from the past 5 years. Regression analysis evaluated the association between payor status and incident diagnosis of diabetes. Data were analyzed in 2023.

Among 872 patients with diabetes hospitalized with COVID-19, 24.0% were uninsured, 34.6% received county-funded charity coverage, 17.1% received Medicaid, and 24.3% received Medicare. The rate of incident diagnosis of diabetes in the total sample was 20.3%; incident diagnosis of diabetes was more common among the uninsured (30.1%) than among county-funded charity coverage (18.2%) and Medicare (11.3%) patients. After adjusting for age, gender, race/ethnicity, and BMI, uninsured patients had higher odds of incident diagnosis of diabetes (AOR=2.64; 95% CI=1.41, 4.92; p=0.002) than Medicare patients. Odds of incident diagnosis of diabetes were similar for county-funded charity coverage and Medicare patients.

Uninsured patients had higher odds of incident diagnosis of diabetes during COVID-19 hospitalization that may have gone undetected without hospitalization. These findings reflect decreased access to preventive care and missed opportunities to screen for diabetes among the uninsured.