Trends in diabetic ketoacidosis‐ and hyperosmolar hyperglycemic state‐related mortality during the COVID‐19 pandemic in the United States: A population‐based study

Author:

He Xinyuan1,Huang Amy Huaishiuan2,Lv Fan3,Gao Xu14,Guo Yuxin1,Liu Yishan1,Hu Xiaoqin1,Xie Jingyi1,Gao Ning1,Jiao Yang5,Wang Yuan1,Zu Jian3,Zhang Lei6789ORCID,Ji Fanpu110111213,Yeo Yee Hui14ORCID

Affiliation:

1. Department of Infectious Diseases The Second Affiliated Hospital of Xi'an Jiaotong University Xi'an China

2. Department of Internal Medicine University of Connecticut School of Medicine Farmington Connecticut USA

3. School of Mathematics and Statistics Xi'an Jiaotong University Xi'an China

4. Division of Gastroenterology The Second Affiliated Hospital of Xi'an Jiaotong University Xi'an China

5. Department of Endocrinology The Second Affiliated Hospital of Xi'an Jiaotong University Xi'an China

6. China‐Australia Joint Research Centre for Infectious Diseases, School of Public Health Xi'an Jiaotong University Health Science Centre Xi'an China

7. Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health Melbourne Australia

8. Central Clinical School, Faculty of Medicine Monash University Melbourne Australia

9. Department of Epidemiology and Biostatistics, College of Public Health Zhengzhou University Zhengzhou China

10. National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy The Second Affiliated Hospital of Xi'an Jiaotong University Xi'an China

11. Global Health Institute, School of Public Health Xi'an Jiaotong University Health Science Center Xi'an China

12. Shaanxi Provincial Clinical Medical Research Center of Infectious Diseases Xi'an China

13. Key Laboratory of Surgical Critical Care and Life Support (Xi'an Jiaotong University), Ministry of Education Xi'an China

14. Karsh Division of Gastroenterology and Hepatology, Cedars‐Sinai Medical Center Los Angeles California USA

Abstract

AbstractBackgroundDuring the pandemic, a notable increase in diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), conditions that warrant emergent management, was reported. We aimed to investigate the trend of DKA‐ and HHS‐related mortality and excess deaths during the pandemic.MethodsAnnual age‐standardized mortality rates related to DKA and HHS between 2006 and 2021 were estimated using a nationwide database. Forecast analyses based on prepandemic data were conducted to predict the mortality rates during the pandemic. Excess mortality rates were calculated by comparing the observed versus predicted mortality rates. Subgroup analyses of demographic factors were performed.ResultsThere were 71 575 DKA‐related deaths and 8618 HHS‐related deaths documented during 2006–2021. DKA, which showed a steady increase before the pandemic, demonstrated a pronounced excess mortality during the pandemic (36.91% in 2020 and 46.58% in 2021) with an annual percentage change (APC) of 29.4% (95% CI: 16.0%–44.0%). Although HHS incurred a downward trend during 2006–2019, the excess deaths in 2020 (40.60%) and 2021 (56.64%) were profound. Pediatric decedents exhibited the highest excess mortality. More than half of the excess deaths due to DKA were coronavirus disease 2019 (COVID‐19) related (51.3% in 2020 and 63.4% in 2021), whereas only less than a quarter of excess deaths due to HHS were COVID‐19 related. A widened racial/ethnic disparity was observed, and females exhibited higher excess mortality than males.ConclusionsThe DKA‐ and HHS‐related excess mortality during the pandemic and relevant disparities emphasize the urgent need for targeted strategies to mitigate the escalated risk in these populations during public health crises.image

Publisher

Wiley

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