Association of Area-Level Socioeconomic Deprivation With Hypoglycemic and Hyperglycemic Crises in US Adults With Diabetes.
Association of Area-Level Socioeconomic Deprivation With Hypoglycemic and Hyperglycemic Crises in US Adults With Diabetes.
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DOI：
10.1001/jamanetworkopen.2021.43597
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发表时间：
2022-01-04
影响因子：
13.8
通讯作者：
McCoy RG
中科院分区：
文献类型：
--
作者：
Kurani SS;Heien HC;Sangaralingham LR;Inselman JW;Shah ND;Golden SH;McCoy RG
这项队列研究考察了与糖尿病保险个人的严重低血糖和糖尿病酮症酸中毒或高血糖高渗透状态相关的急诊科就诊和住院的基于地理的危险因素。在成人糖尿病患者中，县级贫困与低血糖和高血糖危象之间是否存在关联？在这项对1名 116名 361名成年糖尿病患者进行的队列研究中，生活在社会经济贫困加剧地区的患者因严重低血糖和糖尿病酮症酸中毒或高血糖高渗透状态而经历的急诊室就诊和住院率显著高于其他患者水平的风险因素。这项研究的结果表明，县级社会经济贫困是低血糖和高血糖危机的独立风险因素，需要针对糖尿病最佳管理和健康的结构性障碍进行干预。健康的社会决定因素在糖尿病的管理和结果中发挥作用，包括可能危及生命的严重低血糖和糖尿病酮症酸中毒(DKA)或高血糖高渗透状态(HHS)的并发症。尽管一些个人层面的社会经济因素与这些并发症有关，但地区层面的社会经济剥夺的影响尚不清楚。研究地区水平的贫困与因低血糖和高血糖危象(即DKA或HHS)而急诊或住院的风险之间的关系。这项队列研究使用了美国各地私人参保个人和联邦医疗保险优势受益人的明确管理索赔数据。这项分析包括2016年1月1日至2017年12月31日期间符合糖尿病索赔标准的糖尿病成年人。数据分析从2020年11月17日到2021年11月11日进行。使用美国社区调查的17个县级指标，得出了2016年和2017年每个县的面积剥夺指数(ADI)。ADI值根据索引日期应用于居住在每个县的患者，并根据县级ADI五分位数进行分类(五分位数1被剥夺最少，五分位数5被剥夺最多)。2016至2019年间，与初步诊断为低血糖和DKA或HHS(使用急诊科或医院索赔的第一或主要位置的有效诊断代码确定)相关的急诊科就诊或住院次数使用负二项回归模型计算每个ADI五分位数，并根据患者年龄、性别、健康计划类型、合并症、降糖药物类型和该县白人居民的比例进行调整。研究人群包括1 116 361人(563943名女性(50.5%))，平均年龄(SD)64.9(13.2)岁。在这些患者中，343例 726(30.8%)居住在贫困程度最低的县(五分位数1)，121例 810(10.9%)生活在贫困程度最高的县(五分位数5)。调整后的严重低血糖发生率从第1位县的13.54(95%CI，12.91-14.17)/1000人年上升到第5位县的19.13(95%CI，17.62-20.63)/1000人年，相应的发病率比为1.41(95%CI，1.29-1.54；P <； .001)。调整后的DKA或HHS患病率从第1位县的7.49(95%CI，6.96-8.02)/1000人年上升到第5位县的8.37(95%CI，7.5-9.23)/1000人年，相应的发病率比为1.12(95%CI，1.00-1.25；P = .049)。这项研究发现，生活在贫困程度较高的县与严重低血糖和DKA或HHS的风险增加有关。这些可预防的事件集中在贫困程度较高的地区，表明需要针对糖尿病最佳管理和健康的结构性障碍进行干预。
This cohort study examines the geographically based risk factors for emergency department visits and hospitalizations associated with severe hypoglycemia and diabetic ketoacidosis or hyperglycemic hyperosmolar state in insured individuals with diabetes. Is there an association between county-level deprivation and hypoglycemic and hyperglycemic crises among adults with diabetes? In this cohort study of 1 116 361 adults with diabetes, patients who lived in areas of increasing socioeconomic deprivation experienced significantly higher rates of emergency department visits and hospitalizations for severe hypoglycemia and diabetic ketoacidosis or hyperglycemic hyperosmolar state after adjustment for other patient-level risk factors. The findings of this study suggest that county-level socioeconomic deprivation is an independent risk factor for hypoglycemic and hyperglycemic crises, calling for interventions that target the structural barriers to optimal diabetes management and health. Social determinants of health play a role in diabetes management and outcomes, including potentially life-threatening complications of severe hypoglycemia and diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS). Although several person-level socioeconomic factors have been associated with these complications, the implications of area-level socioeconomic deprivation are unknown. To examine the association between area-level deprivation and the risks of experiencing emergency department visits or hospitalizations for hypoglycemic and hyperglycemic crises (ie, DKA or HHS). This cohort study used deidentified administrative claims data for privately insured individuals and Medicare Advantage beneficiaries across the US. The analysis included adults with diabetes who met the claims criteria for diabetes between January 1, 2016, and December 31, 2017. Data analyses were performed from November 17, 2020, to November 11, 2021. Area deprivation index (ADI) was derived for each county for 2016 and 2017 using 17 county-level indicators from the American Community Survey. ADI values were applied to patients who were living in each county based on their index dates and were categorized according to county-level ADI quintile (with quintile 1 having the least deprivation and quintile 5 having the most deprivation). The numbers of emergency department visits or hospitalizations related to the primary diagnoses of hypoglycemia and DKA or HHS (ascertained using validated diagnosis codes in the first or primary position of emergency department or hospital claims) between 2016 and 2019 were calculated for each ADI quintile using negative binomial regression models and adjusted for patient age, sex, health plan type, comorbidities, glucose-lowering medication type, and percentage of White residents in the county. The study population included 1 116 361 individuals (563 943 women [50.5%]), with a mean (SD) age of 64.9 (13.2) years. Of these patients, 343 726 (30.8%) resided in counties with the least deprivation (quintile 1) and 121 810 (10.9%) lived in counties with the most deprivation (quintile 5). Adjusted rates of severe hypoglycemia increased from 13.54 (95% CI, 12.91-14.17) per 1000 person-years in quintile 1 counties to 19.13 (95% CI, 17.62-20.63) per 1000 person-years in quintile 5 counties, corresponding to an incidence rate ratio of 1.41 (95% CI, 1.29-1.54; P < .001). Adjusted rates of DKA or HHS increased from 7.49 (95% CI, 6.96-8.02) per 1000 person-years in quintile 1 counties to 8.37 (95% CI, 7.50-9.23) per 1000 person-years in quintile 5 counties, corresponding to an incidence rate ratio of 1.12 (95% CI, 1.00-1.25; P = .049). This study found that living in counties with a high area-level deprivation was associated with an increased risk of severe hypoglycemia and DKA or HHS. The concentration of these preventable events in areas of high deprivation signals the need for interventions that target the structural barriers to optimal diabetes management and health.
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影响因子：
39.2
作者：
Kind AJ;Jencks S;Brock J;Yu M;Bartels C;Ehlenbach W;Greenberg C;Smith M
通讯作者：
Smith M
DOI：
10.3390/ijerph16050861
发表时间：
2019-03-01
影响因子：
--
作者：
Bell, Caryn N.;Kerr, Jordan;Young, Jessica L.
通讯作者：
Young, Jessica L.
影响因子：
3
作者：
Basu S;Berkowitz SA;Seligman H
通讯作者：
Seligman H
影响因子：
2.7
作者：
Eisenhauer, E.
通讯作者：
Eisenhauer, E.
影响因子：
16.2
作者：
Benoit, Stephen R.;Hora, Israel;Imperatore, Giuseppina
通讯作者：
Imperatore, Giuseppina