与白种人相比，亚裔美国人高血糖急诊的结果：一项调查加权的全国健康公平评估

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2025-05-01 DOI:10.1016/j.jacl.2025.04.068

Oluwatoyosi Awotorebo MD, Ikponmwosa Ogieuhi MD, Aseed Mestahiri MD, Zeth Tolu-Akinnawo MD, Karldon Nwaezeapu MD, Godbless Ajenaghughrure MD, Anuoluwa Oyetoran MD, Kayode Ogunniyi MBBS

{"title":"与白种人相比，亚裔美国人高血糖急诊的结果：一项调查加权的全国健康公平评估","authors":"Oluwatoyosi Awotorebo MD, Ikponmwosa Ogieuhi MD, Aseed Mestahiri MD, Zeth Tolu-Akinnawo MD, Karldon Nwaezeapu MD, Godbless Ajenaghughrure MD, Anuoluwa Oyetoran MD, Kayode Ogunniyi MBBS","doi":"10.1016/j.jacl.2025.04.068","DOIUrl":null,"url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Hyperglycemic emergencies—diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)—are life-threatening conditions that can lead to significant morbidity and mortality. Although previous studies have shown racial differences in diabetes-related complications, data on acute hyperglycemic crises among Asian Americans remain limited.</div></div><div><h3>Objective/Purpose</h3><div>We aimed to investigate disparities in in-hospital outcomes among Asian Americans compared to Caucasians hospitalized for hyperglycemic emergencies, focusing on mortality, mechanical ventilation, vasopressor use, acute kidney injury (AKI), length of stay (LOS), and hospital charges.</div></div><div><h3>Methods</h3><div>Using survey-weighted analyses of a nationally representative inpatient database (2021), we identified adult patients (≥ 18 years) admitted with a principal diagnosis of DKA or HHS. We compared Asian Americans (race code=4) and Caucasians (race code=1). Outcomes were assessed via logistic or linear regression, both unadjusted and adjusted for age, Charlson Comorbidity Index, sex, and median household income quartile by ZIP code.</div></div><div><h3>Results</h3><div>Unadjusted models showed that Asian Americans had higher odds of mortality (odds ratio [OR] 1.25, p=0.033) and AKI (OR 1.09, p=0.002), longer LOS (p=0.029), and greater total charges (p < 0.001) compared to Caucasians, with no significant difference in mechanical ventilation or vasopressor use. After multivariable adjustment, the gap in mortality was no longer statistically significant (OR 1.13, p=0.233), and AKI risk was attenuated (OR 1.05, p=0.082). Differences in LOS also became non-significant (p=0.432). However, Asian Americans continued to incur significantly higher hospital charges (difference + $3,956, p < 0.001).</div></div><div><h3>Conclusions</h3><div>In this survey-weighted, nationally representative analysis, Asian Americans presenting with hyperglycemic emergencies displayed higher unadjusted mortality, AKI rates, and healthcare costs than Caucasians. After adjustment, racial differences in clinical outcomes were largely diminished, but higher total charges persisted. These findings highlight the need for deeper investigation into potential drivers of cost disparities and suggest that tailored interventions may help reduce financial burdens and ensure equitable care for all patients experiencing severe hyperglycemic episodes.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e51-e52"},"PeriodicalIF":3.6000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Outcomes of hyperglycemic emergencies among Asian Americans compared to Caucasians: A survey-weighted nationwide assessment of health equity\",\"authors\":\"Oluwatoyosi Awotorebo MD, Ikponmwosa Ogieuhi MD, Aseed Mestahiri MD, Zeth Tolu-Akinnawo MD, Karldon Nwaezeapu MD, Godbless Ajenaghughrure MD, Anuoluwa Oyetoran MD, Kayode Ogunniyi MBBS\",\"doi\":\"10.1016/j.jacl.2025.04.068\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background/Synopsis</h3><div>Hyperglycemic emergencies—diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)—are life-threatening conditions that can lead to significant morbidity and mortality. Although previous studies have shown racial differences in diabetes-related complications, data on acute hyperglycemic crises among Asian Americans remain limited.</div></div><div><h3>Objective/Purpose</h3><div>We aimed to investigate disparities in in-hospital outcomes among Asian Americans compared to Caucasians hospitalized for hyperglycemic emergencies, focusing on mortality, mechanical ventilation, vasopressor use, acute kidney injury (AKI), length of stay (LOS), and hospital charges.</div></div><div><h3>Methods</h3><div>Using survey-weighted analyses of a nationally representative inpatient database (2021), we identified adult patients (≥ 18 years) admitted with a principal diagnosis of DKA or HHS. We compared Asian Americans (race code=4) and Caucasians (race code=1). Outcomes were assessed via logistic or linear regression, both unadjusted and adjusted for age, Charlson Comorbidity Index, sex, and median household income quartile by ZIP code.</div></div><div><h3>Results</h3><div>Unadjusted models showed that Asian Americans had higher odds of mortality (odds ratio [OR] 1.25, p=0.033) and AKI (OR 1.09, p=0.002), longer LOS (p=0.029), and greater total charges (p < 0.001) compared to Caucasians, with no significant difference in mechanical ventilation or vasopressor use. After multivariable adjustment, the gap in mortality was no longer statistically significant (OR 1.13, p=0.233), and AKI risk was attenuated (OR 1.05, p=0.082). Differences in LOS also became non-significant (p=0.432). However, Asian Americans continued to incur significantly higher hospital charges (difference + $3,956, p < 0.001).</div></div><div><h3>Conclusions</h3><div>In this survey-weighted, nationally representative analysis, Asian Americans presenting with hyperglycemic emergencies displayed higher unadjusted mortality, AKI rates, and healthcare costs than Caucasians. After adjustment, racial differences in clinical outcomes were largely diminished, but higher total charges persisted. These findings highlight the need for deeper investigation into potential drivers of cost disparities and suggest that tailored interventions may help reduce financial burdens and ensure equitable care for all patients experiencing severe hyperglycemic episodes.</div></div>\",\"PeriodicalId\":15392,\"journal\":{\"name\":\"Journal of clinical lipidology\",\"volume\":\"19 3\",\"pages\":\"Pages e51-e52\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of clinical lipidology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1933287425001448\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of clinical lipidology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1933287425001448","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}

引用次数: 0

摘要

背景/简介高血糖紧急情况-糖尿病酮症酸中毒（DKA）和高渗性高血糖状态(HHS) -是危及生命的疾病，可导致显著的发病率和死亡率。虽然先前的研究显示了糖尿病相关并发症的种族差异，但亚裔美国人急性高血糖危机的数据仍然有限。目的/目的：我们旨在调查亚裔美国人与白种人因高血糖急诊住院的差异，重点关注死亡率、机械通气、血管加压剂使用、急性肾损伤（AKI）、住院时间（LOS）和医院收费。方法对全国代表性住院患者数据库（2021年）进行调查加权分析，确定主要诊断为DKA或HHS的成年患者（≥18岁）。我们比较了亚裔美国人（种族代码=4）和高加索人（种族代码=1）。结果通过逻辑回归或线性回归进行评估，包括未调整和调整年龄、查理森合并症指数、性别和按邮政编码划分的家庭收入中位数。结果调整后的模型显示，亚裔美国人的死亡率（比值比[OR] 1.25, p=0.033）和AKI（比值比[OR] 1.09, p=0.002）较高，LOS较长（p=0.029），总费用较高(p <；0.001)，与白种人相比，机械通气或血管加压剂的使用无显著差异。多变量调整后，死亡率差距不再具有统计学意义（OR 1.13, p=0.233）， AKI风险降低（OR 1.05, p=0.082）。LOS的差异也变得不显著（p=0.432）。然而，亚裔美国人继续承担更高的医院费用(差异 + $3,956,p <；0.001)。结论：在这项调查加权的、具有全国代表性的分析中，出现高血糖紧急情况的亚裔美国人比白种人显示出更高的未调整死亡率、AKI发生率和医疗费用。调整后，临床结果的种族差异大大减少，但较高的总费用仍然存在。这些发现强调需要对成本差异的潜在驱动因素进行更深入的调查，并建议量身定制的干预措施可能有助于减轻经济负担，并确保所有经历严重高血糖发作的患者得到公平的护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Outcomes of hyperglycemic emergencies among Asian Americans compared to Caucasians: A survey-weighted nationwide assessment of health equity

Background/Synopsis

Hyperglycemic emergencies—diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)—are life-threatening conditions that can lead to significant morbidity and mortality. Although previous studies have shown racial differences in diabetes-related complications, data on acute hyperglycemic crises among Asian Americans remain limited.

Objective/Purpose

We aimed to investigate disparities in in-hospital outcomes among Asian Americans compared to Caucasians hospitalized for hyperglycemic emergencies, focusing on mortality, mechanical ventilation, vasopressor use, acute kidney injury (AKI), length of stay (LOS), and hospital charges.

Methods

Using survey-weighted analyses of a nationally representative inpatient database (2021), we identified adult patients (≥ 18 years) admitted with a principal diagnosis of DKA or HHS. We compared Asian Americans (race code=4) and Caucasians (race code=1). Outcomes were assessed via logistic or linear regression, both unadjusted and adjusted for age, Charlson Comorbidity Index, sex, and median household income quartile by ZIP code.

Results

Unadjusted models showed that Asian Americans had higher odds of mortality (odds ratio [OR] 1.25, p=0.033) and AKI (OR 1.09, p=0.002), longer LOS (p=0.029), and greater total charges (p < 0.001) compared to Caucasians, with no significant difference in mechanical ventilation or vasopressor use. After multivariable adjustment, the gap in mortality was no longer statistically significant (OR 1.13, p=0.233), and AKI risk was attenuated (OR 1.05, p=0.082). Differences in LOS also became non-significant (p=0.432). However, Asian Americans continued to incur significantly higher hospital charges (difference + $3,956, p < 0.001).

Conclusions

In this survey-weighted, nationally representative analysis, Asian Americans presenting with hyperglycemic emergencies displayed higher unadjusted mortality, AKI rates, and healthcare costs than Caucasians. After adjustment, racial differences in clinical outcomes were largely diminished, but higher total charges persisted. These findings highlight the need for deeper investigation into potential drivers of cost disparities and suggest that tailored interventions may help reduce financial burdens and ensure equitable care for all patients experiencing severe hyperglycemic episodes.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

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.