Socioeconomic and racial disparities in type 1 diabetes adult patients admitted with diabetic ketoacidosis according to large national data set

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2025-05-01 DOI:10.1016/j.jacl.2025.04.072

Fernando Mateo MD, Sila Mateo Faxas MD, Muayad Alzamara MD, Fayaz Khan MD, Amin Eshghabadi MD, Godbless Ajenaghughrure MD, M Kenan Rahima MD

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引用次数: 0

Abstract

Background/Synopsis

Racial and socioeconomic disparities significantly impact healthcare outcomes in adults with type 1 diabetes mellitus (T1DM), particularly in the incidence and severity of diabetic ketoacidosis (DKA).

Objective/Purpose

This study evaluates disparities in hospitalization rates, clinical outcomes, and healthcare resource utilization among adults admitted with DKA.

Methods

We conducted a retrospective analysis using a national inpatient database 2017-2021, identifying adult hospitalizations for DKA in patients who has T1DM. Patients were stratified by race (White, Black, Hispanic, Asian, and other) and socioeconomic factors such as insurance type. Baseline demographics and clinical outcomes were compared. Multivariate logistic regression models were used to assess disparities in mortality, length of stay (LOS), and hospitalization costs.

Results

A total of 729,784 adult DKA hospitalizations with T1DM were included. Caucasian patients represented the largest proportion (60.8%), followed by African American (22.7%), Hispanic (10.4%), and Asian (0.9%) patients. Insurance status varied significantly by race, with Medicaid being the predominant insurance among Black (44.5%) and Hispanic (40.1%) patients, while private insurance was more common among White (31.9%) and Asian (35.9%) patients (P < 0.001).

Clinical outcomes also varied significantly. In-hospital mortality was highest among Asian patients (1.8%, OR 1.89, P = 0.003), while White (1.1%), Black (0.8%, OR 1.1, P = 0.18), and Hispanic (0.9%, OR 1.3, P = 0.005) patients had lower mortality rates. The need for invasive mechanical ventilation was highest in Asian patients (4.4%, OR 1.3, P = 0.04) compared to White (3.5%), Black (2.9%), and Hispanic (2.7%) patients. Asian patients also had the longest LOS (4.5 days, OR 1.23, P < 0.01) and highest hospitalization costs ($15,209, OR 1.48, P < 0.01) compared to White patients (LOS 3.8 days, cost $10,556). Hispanic patients had higher total costs ($11,835, OR 1.27, P < 0.01), while Black patients had the lowest hospital costs ($10,225, OR 1.06, P < 0.01)

Conclusions

Socioeconomic and racial disparities significantly impact DKA-related hospitalizations and outcomes in adults with T1DM. Black and Hispanic patients experience higher rates of admission and worse clinical outcomes, while Asian patients have greater resource utilization and higher mortality risk. Addressing these disparities requires targeted interventions to improve access to preventive care, reduce financial barriers, and enhance diabetes management in vulnerable populations.

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根据大型国家数据集，入院的1型糖尿病成人患者的社会经济和种族差异

背景/摘要种族和社会经济差异显著影响成人1型糖尿病（T1DM）患者的医疗结局，尤其是糖尿病酮症酸中毒（DKA）的发生率和严重程度。目的/目的本研究评估成人DKA住院率、临床结果和医疗资源利用的差异。方法：我们使用2017-2021年国家住院患者数据库进行回顾性分析，确定T1DM患者因DKA住院的成人病例。患者按种族（白人、黑人、西班牙裔、亚洲人等）和社会经济因素（如保险类型）进行分层。比较基线人口统计学和临床结果。多变量logistic回归模型用于评估死亡率、住院时间（LOS）和住院费用的差异。结果共纳入729,784例成人T1DM住院患者。白种人患者所占比例最大（60.8%），其次是非洲裔美国人（22.7%）、西班牙裔（10.4%）和亚裔（0.9%）患者。保险状况因种族而异，医疗补助是黑人（44.5%）和西班牙裔（40.1%）患者的主要保险，而私人保险在白人（31.9%）和亚洲（35.9%）患者中更为常见(P <；0.001)。临床结果也有显著差异。住院死亡率最高的是亚洲患者（1.8%,OR 1.89, P = 0.003），而白人（1.1%）、黑人（0.8%,OR 1.1, P = 0.18）和西班牙裔（0.9%,OR 1.3, P = 0.005）患者的死亡率较低。亚洲患者对有创机械通气的需求最高（4.4%,OR 1.3, P = 0.04），而白人（3.5%）、黑人（2.9%）和西班牙裔（2.7%）患者的需求最高。亚洲患者的LOS也最长(4.5天，OR 1.23, P <；0.01)和最高住院费用(15,209美元，OR 1.48, P <；0.01)，而白人患者（LOS 3.8天，费用10,556美元）。西班牙裔患者的总成本更高(11,835美元，OR 1.27, P <；0.01)，而黑人患者的住院费用最低(10,225美元，OR 1.06, P <；0.01)结论社会经济和种族差异显著影响成人T1DM患者与dka相关的住院治疗和转归。黑人和西班牙裔患者的住院率更高，临床结果更差，而亚裔患者的资源利用率更高，死亡风险更高。解决这些差异需要有针对性的干预措施，以改善获得预防保健的机会，减少资金障碍，并加强弱势人群的糖尿病管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. Sections of Journal of clinical lipidology will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.