Increased risk of diabetic ketoacidosis in an Urban, United States, safety-net emergency department in the COVID-19 era

IF 0.4 Q4 MEDICINE, RESEARCH & EXPERIMENTAL
E. Burner, Lucy Liu, S. Terp, S. Arora, C. Lam, M. Menchine, D. Dworkis, S. Axeen
{"title":"Increased risk of diabetic ketoacidosis in an Urban, United States, safety-net emergency department in the COVID-19 era","authors":"E. Burner, Lucy Liu, S. Terp, S. Arora, C. Lam, M. Menchine, D. Dworkis, S. Axeen","doi":"10.3934/medsci.2023004","DOIUrl":null,"url":null,"abstract":"Aims The incidence of diabetic ketoacidosis (DKA) increased during the COVID-19 pandemic but estimates from low-resource settings are limited. We examined the odds of DKA among emergency department (ED) visits in the Los Angeles County Department of Health Services (DHS) (1) during the COVID-19 pandemic compared to the pre-COVID era, (2) without active COVID infections, and (3) stratified by effect modifiers to identify impacted sub-groups. Methods We estimated the odds of DKA from 400,187 ED visits pre-COVID era (March 2019–Feb 2020) and 320,920 ED visits during the COVID era (March 2020–Feb 2021). Our base model estimated the odds of DKA based on the COVID era. Additional specifications stratified by effect modifiers, controlled for confounders, and limited to visits without confirmed COVID-19 disease. Results After adjusting for triage acuity and interaction terms for upper respiratory infections and payor, the odds of DKA during the COVID era were 27% higher compared to the pre-COVID era (95%CI 14–41%, p < 0.001). In stratified analyses, visits with private payors had a 112% increased odds and visits with Medicaid had a 20% increased odds of DKA during the COVID era (95%CI 7–36%, p = 0.003). Conclusions We identified increased odds of DKA during the COVID pandemic, robust to a variety of specifications. We found differential effects by the payor; with increased odds during COVID for privately-insured patients.","PeriodicalId":43011,"journal":{"name":"AIMS Medical Science","volume":null,"pages":null},"PeriodicalIF":0.4000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"AIMS Medical Science","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3934/medsci.2023004","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
引用次数: 0

Abstract

Aims The incidence of diabetic ketoacidosis (DKA) increased during the COVID-19 pandemic but estimates from low-resource settings are limited. We examined the odds of DKA among emergency department (ED) visits in the Los Angeles County Department of Health Services (DHS) (1) during the COVID-19 pandemic compared to the pre-COVID era, (2) without active COVID infections, and (3) stratified by effect modifiers to identify impacted sub-groups. Methods We estimated the odds of DKA from 400,187 ED visits pre-COVID era (March 2019–Feb 2020) and 320,920 ED visits during the COVID era (March 2020–Feb 2021). Our base model estimated the odds of DKA based on the COVID era. Additional specifications stratified by effect modifiers, controlled for confounders, and limited to visits without confirmed COVID-19 disease. Results After adjusting for triage acuity and interaction terms for upper respiratory infections and payor, the odds of DKA during the COVID era were 27% higher compared to the pre-COVID era (95%CI 14–41%, p < 0.001). In stratified analyses, visits with private payors had a 112% increased odds and visits with Medicaid had a 20% increased odds of DKA during the COVID era (95%CI 7–36%, p = 0.003). Conclusions We identified increased odds of DKA during the COVID pandemic, robust to a variety of specifications. We found differential effects by the payor; with increased odds during COVID for privately-insured patients.
COVID-19时代美国城市安全网急诊科糖尿病酮症酸中毒风险增加
目的:在2019冠状病毒病大流行期间,糖尿病酮症酸中毒(DKA)的发病率有所增加,但对资源匮乏地区的估计有限。我们检查了洛杉矶县卫生服务部(DHS)急诊科(ED)就诊中DKA的几率(1)在COVID-19大流行期间与前COVID时代相比,(2)没有活跃的COVID感染,(3)通过效应修饰因子分层以确定受影响的亚组。方法我们估计了COVID时代前(2019年3月- 2020年2月)400,187次ED就诊和COVID时代(2020年3月- 2021年2月)320,920次ED就诊的DKA几率。我们的基础模型基于COVID时代估计了DKA的几率。其他规格按效果调节剂分层,控制混杂因素,限制未确诊COVID-19疾病的访问。结果在调整上呼吸道感染和付款人的分诊灵敏度和相互作用条件后,与前相比,COVID时期DKA的几率高27% (95%CI 14-41%, p < 0.001)。在分层分析中,在COVID时代,私人支付者的就诊几率增加了112%,医疗补助的就诊几率增加了20% (95%CI 7-36%, p = 0.003)。结论:我们发现在COVID大流行期间,DKA的几率增加,符合各种规格。我们发现付款人的不同影响;私人保险患者在COVID期间的几率增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
AIMS Medical Science
AIMS Medical Science MEDICINE, RESEARCH & EXPERIMENTAL-
自引率
14.30%
发文量
20
审稿时长
12 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信