Association of Area Deprivation and Diabetic Ketoacidosis Readmissions: Comparative Risk Analysis of Adults vs Children With Type 1 Diabetes

Abstract

Abstract Objective Recurrent diabetic ketoacidosis (DKA) is associated with mortality in adults and children with type 1 diabetes (T1D). We aimed to evaluate the association of area deprivation and other patient factors with recurrent DKA in pediatric patients compared with adults. Research Design and Methods This cross-sectional study used the Maryland Health Services Cost Review Commission’s database to identify patients with T1D admitted for DKA between 2012 and 2017. Area deprivation and other variables were obtained from the first DKA admission of the study period. Multivariable logistic regression analysis was performed to determine predictors of DKA readmissions. Interactions (Ints) evaluated differences among the groups. Results There were 732 pediatric and 3305 adult patients admitted with DKA. Area deprivation was associated with higher odds of readmission in pediatric patients than in adults. Compared with the least deprived, moderately deprived pediatric patients had an OR of 7.87-(95% CI, 1.02 to 60.80) compared with no change in odds in adults for four or more readmissions (Pint < 0.01). Similar odds were observed in the most deprived pediatric patients, which differed significantly from the OR of 2.23 (95% CI, 1.16 to 4.25) in adults (Pint of 0.2). Moreover, increasing age, female sex, Hispanic ethnicity, and discharge against medical advice conferred a high odds for four or more readmissions in pediatric patients compared with adults. Conclusion Area deprivation was predictive of recurrent DKA admissions, with a more pronounced influence in pediatric than adult patients with T1D. Further studies are needed to understand the mechanisms behind these associations and address disparities specific to each population.