Outcomes of hyperglycemic emergencies among African Americans compared to Caucasians: A large-scale nationwide analysis

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2025-05-01 DOI:10.1016/j.jacl.2025.04.069

Oluwatoyosi Awotorebi MD, Ikponmwosa Ogieuhi MD, Aseed Mestahiri MD, Godbless Ajenaghughrure MD, Derek Ugwendum MD, Karldon Nwaezeapu MD, Anuoluwa Oyetoran MD, Kayode Ogunniyi MBBS

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Abstract

Background/Synopsis

Hyperglycemic emergencies, including diabetic ketoacidosis and hyperglycemic hyperosmolar states, remain critical contributors to morbidity and mortality among patients with diabetes. Although previous studies have highlighted racial disparities in diabetes care, limited large-scale data exist on in-hospital outcomes specifically comparing African Americans and Caucasians with hyperglycemic emergencies, particularly with mortality as a primary endpoint.

Objective/Purpose

To investigate whether African Americans differ from Caucasians in in-hospital mortality, critical interventions (mechanical ventilation, vasopressor use), and resource utilization (acute kidney injury [AKI], length of stay [LOS], total hospital charges [TOTCHG]) when hospitalized for hyperglycemic emergencies.

Methods

We analyzed a nationally representative administrative database, identifying adults (≥ 18 years) hospitalized primarily for hyperglycemic emergencies via ICD-10 codes. Our unweighted subpopulation (n=39,899) expanded to weighted totals of 129,115 admissions for Caucasians (Race=1) and 70,380 admissions for African Americans (Race=2). We employed survey-weighted logistic regression to assess mortality, mechanical ventilation, vasopressor use, and AKI, and linear regression to evaluate LOS and TOTCHG. Adjusted models controlled for age, Charlson Comorbidity Index, and sex.

Results

In unadjusted analyses, African Americans had lower odds of mortality (odds ratio [OR] ∼ 0.53), mechanical ventilation (OR ∼ 0.80), and vasopressor use (OR ∼ 0.62), yet exhibited higher odds of AKI (OR ∼ 1.39) compared to Caucasians. They also showed a modest increase in LOS (by ∼ 0.35 days) and hospital charges (by ∼ $1,936). After adjusting for covariates, African Americans remained significantly less likely to die in hospital (OR=0.61, p=0.002), require mechanical ventilation (OR=0.83, p=0.049), or need vasopressor support (OR=0.67, p=0.013), but were more likely to develop AKI (OR=1.54, p < 0.001). They also experienced an additional 0.39 days of hospitalization (p < 0.001) and incurred $2,190 higher charges (p=0.009) on average.

Conclusions

In this large, nationally representative cohort, African Americans demonstrated lower in-hospital mortality and decreased use of critical interventions compared to Caucasians despite a heightened risk of AKI and modestly increased LOS and costs. These findings highlight the complex interplay between disease severity, comorbid burden, and possible underlying systemic or biological factors. Further investigation into social determinants, baseline health status, and patterns of care is warranted to optimize management and reduce inequities in hyperglycemic emergency outcomes.

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与白种人相比，非裔美国人高血糖急诊的结果：一项大规模的全国性分析

背景/摘要：包括糖尿病酮症酸中毒和高血糖高渗状态在内的高血糖急症仍然是糖尿病患者发病率和死亡率的重要因素。虽然先前的研究强调了糖尿病护理中的种族差异，但关于住院结果的大规模数据有限，特别是比较非裔美国人和白种人的高血糖紧急情况，特别是以死亡率为主要终点。目的/目的探讨非裔美国人在高血糖急诊住院时的住院死亡率、关键干预措施（机械通气、血管加压剂使用）和资源利用（急性肾损伤[AKI]、住院时间[LOS]、住院总费用[TOTCHG]）方面是否与白种人不同。方法：我们分析了一个具有全国代表性的行政数据库，通过ICD-10编码识别主要因高血糖紧急情况住院的成人（≥18岁）。我们的未加权亚群（n=39,899）扩大到白人（种族=1）的129,115名入学人数和非洲裔美国人（种族=2）的70,380名入学人数。我们采用调查加权logistic回归评估死亡率、机械通气、血管加压剂使用和AKI，并采用线性回归评估LOS和TOTCHG。调整后的模型控制了年龄、查理森合并症指数和性别。结果在未经调整的分析中，非裔美国人的死亡率（比值比[OR] ~ 0.53）、机械通气（OR ~ 0.80）和血管加压剂的使用（OR ~ 0.62）较低，但与高加索人相比，其AKI的发生率较高（OR ~ 1.39）。他们还显示出LOS（增加约0.35天）和医院费用（增加约1936美元）的适度增加。调整协变量后，非裔美国人在医院死亡（OR=0.61, p=0.002）、需要机械通气（OR=0.83, p=0.049）或需要血管加压素支持（OR=0.67, p=0.013）的可能性仍显著降低，但发生AKI的可能性更高(OR=1.54, p <；0.001)。他们还额外经历了0.39天的住院治疗(p <；0.001)，平均收费增加2,190元（p=0.009）。结论：在这个具有全国代表性的大型队列中，非裔美国人表现出较低的住院死亡率和较低的关键干预措施的使用，尽管AKI风险增加，LOS和费用略有增加。这些发现强调了疾病严重程度、合并症负担和可能潜在的系统或生物因素之间复杂的相互作用。有必要进一步调查社会决定因素、基线健康状况和护理模式，以优化管理并减少高血糖急诊结果的不公平。

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.