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Social factors associated with prolonged hospitalization among diabetic children
Heather T Keenan1, Carol M Foster, Susan L Bratton
1Departments of Pediatrics and Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA. hkeenan@med.unc.edu
Insights
Social factors like race and poverty increase hospital admission risk for children with type 1 diabetes complications, leading to longer stays. Targeted education and support are crucial for these vulnerable pediatric populations.
Area of Science:
- Pediatric Endocrinology
- Health Disparities
- Public Health
Background:
- Diabetic ketoacidosis (DKA) and diabetic coma are serious complications of type 1 diabetes mellitus (DM).
- Understanding social determinants of health is crucial for managing pediatric DM.
- Previous research has not fully elucidated social factors linked to DKA/coma admissions and prolonged hospital stays in children.
Purpose of the Study:
- To identify social factors associated with increased risk of hospital admission for diabetic ketoacidosis (DKA) or diabetic coma in children.
- To determine social factors contributing to prolonged hospital stays in pediatric patients with type 1 DM.
Main Methods:
- A retrospective cohort study using the National Inpatient Sample (NIS) database.
- Inclusion criteria: children (
- Analysis of patient demographics (age, race, gender), insurance status, and residence in poverty areas; prolonged stay defined as >/=7 days.
Main Results:
- 8443 children with DKA and 123 with type 1 DM and coma were identified.
- Nonwhite race, Medicaid insurance, and residence in poverty areas were significantly associated with prolonged hospital stays (ORs ranging from 1.3 to 2.0).
- Younger age was also a predictor of prolonged hospital stay.
Conclusions:
- Nonwhite and economically disadvantaged children face higher risks of DM complications and extended hospitalizations.
- These findings highlight significant health disparities in pediatric diabetes care.
- Targeted interventions, including intensive diabetes education and outpatient support, are recommended for at-risk pediatric populations to improve outcomes and reduce healthcare costs.
Objective:
To determine social factors associated with increased risk of hospital admission from diabetic ketoacidosis (DKA) or diabetic coma as well as risk of prolonged hospital stay.
Methods:
A cohort of all children (/=7 days.
Results:
A total of 8443 children with a primary hospital diagnosis of DKA and 123 children with type 1 DM and coma were identified; 55% of the children were girls, 32% were nonwhite, 29% received Medicaid insurance, and 33% resided in areas of poverty. Children with prolonged hospital stay were significantly more likely to be of nonwhite race (odds ratio [OR]: 2.0; 95% confidence interval [CI]: 1.6-2.5), to receive Medicaid insurance (OR: 1.4; 95% CI: 1.1-1.7), to live in areas of poverty (OR: 1.3; 95% CI: 1.1-1.7), and to be of younger age.
Conclusions:
When compared with state census data, nonwhite and poor children were more likely to be admitted with complications of DM and to have significantly prolonged and expensive hospital stays. These children should be targeted for intensive diabetes education and outpatient medical support both to improve their health and potentially to decrease total health care costs.