Association of socioeconomic status and DKA readmission in adults with type 1 diabetes: analysis of the US National Readmission Database

Abstract

ObjectiveTo identify patient and hospital predictors of recurrent diabetic ketoacidosis (DKA) admissions in adults in the USA with type 1 diabetes, focusing on socioeconomic indicators.Research design and methodsThis cross-sectional study used the National Readmission Database to identify adult patients with type 1 diabetes admitted for DKA between 2010 and 2015. The index DKA admission was defined as the first admission within the calendar year and the primary outcome was recurrent DKA admission(s) within the same calendar year. Multivariable logistic regression analysis was performed using covariates of patient and hospital factors at the index admission to determine the odds of DKA readmission(s).ResultsAmong 181 284 index DKA admissions, 39 693 (22%) had at least one readmission within the calendar year, of which 33 931 (86%) and 5762 (14%) had 1–3 and ≥4 DKA readmissions, respectively. When compared with the highest income quartile, patients in the first and second income quartiles had 46% (95% CI 30% to 64%) and 34% (95% CI 19% to 51%) higher odds of four or more DKA readmissions, respectively. Medicaid and Medicare insurance were both associated with a 3.3-fold adjusted risk (95% CI 3.0 to 3.7) for ≥4 readmissions compared with private insurance, respectively. Younger age, female sex, and discharge against medical advice were also predictive.ConclusionsLower socioeconomic status and Medicaid insurance are strong predictors of DKA readmissions in adults with type 1 diabetes in the USA. Further studies are needed to understand the mediators of this association to inform multilevel interventions for this high-risk population.Significance of the studyThe association of socioeconomic status (SES) and hospital admission for DKA has been studied in pediatrics with type 1 diabetes, but the data in adults are limited, and studies evaluating recurrent DKA admissions are scarcer. To our knowledge, this is the first study to describe predictors of recurrent DKA admissions in adults with type 1 diabetes on a national level in the USA. We found that those at highest risk of recurrent DKA are young women with low SES who had Medicaid or Medicare insurance. These findings should prompt further studies to explore the mediators of these disparities in patients with type 1 diabetes, as recurrent DKA results in high healthcare utilization and increased risk of long-term complications.

Sociodemographic, Clinical, and Treatment-Related Factors Associated With Hyperglycemic Crises Among Adults With Type 1 or Type 2 Diabetes in the US From 2014 to 2020

“…In the present study, incidence and risk of hyperglycemic crises was disproportionately higher for patients with lower income, a finding supporting the need for policies and systems to ensure improved access to affordable glucose-lowering therapies. 25,26 Building on earlier work in different populations, 27,28 we found that for individuals with type 1 diabetes, the adjusted rate of hyperglycemic crises was 101.52 events per 1000 person-years among patients with low income (<$40 000) compared with 26.25 events per 1000 person-years among patients with high income (Ն$200 000). Income-based disparities in hyperglycemic crisis risk were also detected among patients with type 2 diabetes: 5.78 vs 2.23 per 1000 person-years, respectively.…”

Clinical Outcomes in Patients With Isolated or Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: A Retrospective, Hospital-Based Cohort Study

“…About one in every five patients with DKA is readmitted within 30 days (33). In this study, we included only first admissions, as recurrent events would have significant impact on the interpretation of our results (lack of survival data outside the Emory Healthcare System).…”

HLA class I genes modulate disease risk and age at onset together with DR-DQ in Chinese patients with insulin-requiring type 1 diabetes

“…We observed a high percentage of DKA and female/male ratio in our study. Interestingly, previous studies suggested that female sex was associated with an increased risk of DKA [ 36 – 39 ]. We suspect that this may be due to patient selection.…”