National Trends in Pediatric Admissions for Diabetic Ketoacidosis, 2006-2016.
National Trends in Pediatric Admissions for Diabetic Ketoacidosis, 2006-2016.
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DOI：
10.1210/clinem/dgab287
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发表时间：
2021-07-13
期刊：
影响因子：
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通讯作者：
Wisk, Lauren E
中科院分区：
文献类型：
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作者：
Everett, Estelle M;Copeland, Timothy P;Wisk, Lauren E
背景和证据：美国糖尿病酮症酸中毒（DKA）的发病率正在上升。先前的研究表明年轻人群的发病率较高，但没有研究评估儿科人群的全国趋势和亚组的差异。因此，我们试图研究全国儿童DKA的趋势。方法：我们使用2006年，2009年，2012年和2016年儿童住院患者数据库，在全国代表性的≤ 20岁青年住院样本中确定儿童DKA住院。我们估计了每10000例住院和每10000例人群的DKA住院率、费用、住院时间（LOS）以及所有住院患者和人口统计学亚组随时间的趋势。使用回归模型评估各亚组随时间推移DKA发生率的差异。结果：2006年至2016年，有149 535例DKA入院。每次入院的未校正DKA发生率从2006年的120.5（95% CI，115.9-125.2）增加至2016年的217.7（95% CI，208.3-227.5）。平均入场费由14 548元（95%置信区间，13 971美元-15 125美元）降至20 997美元（95% CI，19 973- 22 022美元），而平均LOS从2.51（95% CI，2.45-2.57）天降至2.28（95% CI，2.23-2.33）天。DKA发生率较高的人群包括18至20岁的女性、没有私人保险、收入较低以及来自非城市地区的黑人青年。年轻的成年人，男性，那些没有私人保险，从非城市地区有更大的增加DKA率across time.CONCLUSIONS：儿科DKA入院率上升了40%，在美国和弱势亚组仍然处于最高风险。进一步的研究应该描述这些群体所经历的挑战，以提供干预措施来减轻他们的DKA风险，并解决全国DKA率上升的问题。
BACKGROUND AND OBJECTIVES: Diabetic ketoacidosis (DKA) rates in the United States are rising. Prior studies suggest higher rates in younger populations, but no studies have evaluated national trends in pediatric populations and differences by subgroups. As such, we sought to examine national trends in pediatric DKA.METHODS: We used the 2006, 2009, 2012, and 2016 Kids' Inpatient Database to identify pediatric DKA admissions among a nationally representative sample of admissions of youth ≤20 years old. We estimate DKA admission per 10 000 admissions and per 10 000 population, charges, length of stay (LOS), and trends over time among all hospitalizations and by demographic subgroups. Regression models were used to evaluate differences in DKA rates within subgroups overtime.RESULTS: Between 2006 and 2016, there were 149 535 admissions for DKA. Unadjusted DKA rate per admission increased from 120.5 (95% CI, 115.9-125.2) in 2006 to 217.7 (95% CI, 208.3-227.5) in 2016. The mean charge per admission increased from $14 548 (95% CI, $13 971-$15 125) in 2006 to $20 997 (95% CI, $19 973-$22 022) in 2016, whereas mean LOS decreased from 2.51 (95% CI, 2.45-2.57) to 2.28 (95% CI, 2.23-2.33) days. Higher DKA rates occurred among 18- to 20-year-old females, Black youth, without private insurance, with lower incomes, and from nonurban areas. Young adults, men, those without private insurance, and from nonurban areas had greater increases in DKA rates across time.CONCLUSIONS: Pediatric DKA admissions have risen by 40% in the United States and vulnerable subgroups remain at highest risk. Further studies should characterize the challenges experienced by these groups to inform interventions to mitigate their DKA risk and to address the rising DKA rates nationally.