Emergency Department Visits for Diabetes Fell During COVID-19

Emergency department (ED) visits among adults with diabetes dropped significantly during the COVID-19 pandemic, despite widespread disruptions to routine care at the time, according to a new study published in BMC Public Health.¹

The study examined data from 9051 adults with diabetes using the National Health Interview Survey (NHIS) from 2019 to 2021. Researchers compared ED visits before and during the pandemic while accounting for differences in health access, insurance, socioeconomic factors, and self-reported health status. The main outcome variable was any ED visit in the last year.

The study sample was 58.5% non-Hispanic White, 17.2% Hispanic, and 15.6% non-Hispanic Black, with 19.5% identifying as immigrants. Nearly half (46.2%) were 65 years or older.

Pandemic Years Saw Fewer ED Visits

Overall, the percentage of patients with diabetes visiting the ED dropped during COVID-19, from 36.2% in 2019 to 32% the next year and 31.8% the year after. Compared with 2019, adults with diabetes were 15% less likely to visit the ED in 2020 (95% CI, 0.73-0.98) and 24% less likely in 2021 (95% CI, 0.65-0.88).

“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,” the authors said.

Factors Linked to ED Visits

Researchers also looked at factors increasing the risk of ED utilization across all 3 study years and found that delayed care due to cost was linked to a 65% higher likelihood of ED visits among the study sample. Having a disability was tied to a 64% higher likelihood overall but dropped noticeably from a 97% higher risk in 2019 to 46% and 48% higher risks the following 2 years.

“Individuals with a disability may face compounded challenges in accessing regular primary care, such as mobility issues or communication barriers, leading to poorer disease management and a higher likelihood of ED visits,” the authors said.

Race also played a role, as Black adults with diabetes were 51% more likely to visit the ED than White adults overall. This disparity expanded with the onset of the pandemic, as Black adults were already 48% and 49% more likely to visit the ED than White adults in 2019 and 2020, jumping to 59% higher odds in 2021. However, odds were similar between Hispanic and White adults. Patients in the “non-Hispanic other” category were 15% more likely than their White peers to visit the ED between 2019 and 2021.

Immigrants with diabetes were 27% less likely to visit the ED compared with adults born in the US, which researchers said may not necessarily be a good thing and could be a result of several factors, such as limited diabetes education or restricted access to care.²

“Immigrants are more likely to delay medical care due to cost, less likely to visit an ED, and less likely to use telehealth during the pandemic as per the past literature,” they added.¹

Seeking emergency care seemed to decrease with age. Compared with adults aged 18 to 34 years, those aged 35 to 49 years were 18% less likely to use emergency care, those aged 50 to 64 years were 42% less likely, and those aged 65 and older were 43% less likely. According to the authors, this could indicate better disease management and care continuity among older adults compared with their younger counterparts, but it could also suggest younger adults are underutilizing or facing barriers to health care.

Persistent Socioeconomic Disparities

In 2021, use of the Supplemental Nutrition Assistance Program (SNAP) was associated with a 30% higher likelihood of ED visits. Additionally, patients who were unemployed in the prior week were 21% more likely to visit the ED, and those without health insurance were 67% more likely than those with private insurance. According to researchers, this pattern suggests patients facing socioeconomic barriers are more likely to rely on emergency services for their health care needs.

“The results help hospital and health administrators to anticipate patient surges and encourage partnerships with SNAP programs, disability services, and minority health organizations to improve diabetic care before utilization of high-cost ED visits,” they said.

The authors acknowledged a few limitations. Because the NHIS relies on self-reported data, recall bias may have affected estimates of ED use. The dataset also lacked information on diabetes type, severity, or complications that could influence emergency care needs, and unmeasured pandemic factors like regional restrictions or telehealth availability may have influenced results.

“These findings highlight the need for improved health care infrastructure and targeted interventions to ensure that vulnerable populations have equitable access to routine care, both during public health emergencies and beyond, to prevent negative health outcomes in patients with diabetes,” the researchers concluded.

References

1. Mosalpuria K, Sharareh N, Sanuade OA, Onigbogi O, Asare AO. Impact of the COVID-19 pandemic on emergency department visits in adults with diabetes: findings from the national health interview survey. BMC Public Health. 2025;25(1):3406. doi:10.1186/s12889-025-24776-9
2. Siddiq H, Choi KR, Jackson N, et al. Determinants to tele-mental health services utilization among california adults: do immigration-related variables matter? J Immigr Minor Health. 2024;26(6):966-976. doi:10.1007/s10903-024-01628-z