The Incidence of Diabetic Ketoacidosis During "Emerging Adulthood" in the USA and Canada: a Population-Based Study.
diabetic ketoacidosis, emerging adulthood
healthcare access
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
07 2019
07 2019
Historique:
received:
26
10
2018
accepted:
20
03
2019
revised:
20
12
2018
pubmed:
9
5
2019
medline:
31
10
2020
entrez:
9
5
2019
Statut:
ppublish
Résumé
As children with diabetes transition to adulthood, they may be especially vulnerable to diabetic ketoacidosis (DKA). Cross-national comparisons may inform efforts to avoid this complication. To compare DKA hospitalization rates in the USA and Manitoba, Canada, during the vulnerable years known as "emerging adulthood." Cross-sectional study using inpatient administrative databases in the USA (years 1998-2014) and Manitoba, Canada (years 2003-2013). Individuals aged 12-30 years hospitalized with DKA, identified using ICD-9 (USA) or ICD-10 codes (Manitoba). DKA hospitalization rates per 10,000 population by age (with a focus on those aged 15-17 vs. 19-21). Admissions were characterized by gender, socioeconomic status, year of hospitalization, and mortality during hospitalization. The DKA rate was slightly higher in the USA among those aged 15-17: 4.8 hospitalizations/10,000 population vs. 3.7/10,000 in Manitoba. Among those aged 19-21, the DKA hospitalization rate rose 90% in the USA to 9.2/10,000, vs. 23% in Manitoba, to 4.5/10,000. In both the USA and Manitoba, rates were higher among those from poorer areas, and among adolescent girls compared with adolescent boys. DKA admissions rose gradually during the period under study in the USA, but not in Manitoba. In years of "emerging adulthood," the Canadian healthcare system appears to perform better than that of the USA in preventing hospitalizations for DKA. Although many factors likely contribute to this difference, universal and seamless coverage over the lifespan in Canada may contribute.
Sections du résumé
BACKGROUND
As children with diabetes transition to adulthood, they may be especially vulnerable to diabetic ketoacidosis (DKA). Cross-national comparisons may inform efforts to avoid this complication.
OBJECTIVE
To compare DKA hospitalization rates in the USA and Manitoba, Canada, during the vulnerable years known as "emerging adulthood."
DESIGN
Cross-sectional study using inpatient administrative databases in the USA (years 1998-2014) and Manitoba, Canada (years 2003-2013).
PARTICIPANTS
Individuals aged 12-30 years hospitalized with DKA, identified using ICD-9 (USA) or ICD-10 codes (Manitoba).
MAIN MEASURES
DKA hospitalization rates per 10,000 population by age (with a focus on those aged 15-17 vs. 19-21). Admissions were characterized by gender, socioeconomic status, year of hospitalization, and mortality during hospitalization.
KEY RESULTS
The DKA rate was slightly higher in the USA among those aged 15-17: 4.8 hospitalizations/10,000 population vs. 3.7/10,000 in Manitoba. Among those aged 19-21, the DKA hospitalization rate rose 90% in the USA to 9.2/10,000, vs. 23% in Manitoba, to 4.5/10,000. In both the USA and Manitoba, rates were higher among those from poorer areas, and among adolescent girls compared with adolescent boys. DKA admissions rose gradually during the period under study in the USA, but not in Manitoba.
CONCLUSIONS
In years of "emerging adulthood," the Canadian healthcare system appears to perform better than that of the USA in preventing hospitalizations for DKA. Although many factors likely contribute to this difference, universal and seamless coverage over the lifespan in Canada may contribute.
Identifiants
pubmed: 31065950
doi: 10.1007/s11606-019-05006-6
pii: 10.1007/s11606-019-05006-6
pmc: PMC6614229
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1244-1250Références
Diabet Med. 1999 Jun;16(6):466-71
pubmed: 10391393
Am Psychol. 2000 May;55(5):469-80
pubmed: 10842426
JAMA. 1992 Nov 4;268(17):2388-94
pubmed: 1404795
Pediatr Diabetes. 2005 Jun;6(2):79-83
pubmed: 15963034
JAMA. 2007 Mar 14;297(10):1073-84
pubmed: 17356028
Diabetes Care. 2007 Oct;30(10):2441-6
pubmed: 17666466
Diabetes Care. 2008 Aug;31(8):1529-30
pubmed: 18458141
J R Soc Med. 2009 Jul;102(7):298-303
pubmed: 19605862
Pediatrics. 2009 Dec;124(6):e1134-41
pubmed: 19933731
BMJ. 2011 Jul 07;343:d4092
pubmed: 21737470
Diabetes Care. 2011 Sep;34(9):1891-6
pubmed: 21775761
Diabetes Care. 2011 Nov;34(11):2477-85
pubmed: 22025785
Diabetes Care. 2012 Aug;35(8):1716-22
pubmed: 22699289
Diabet Med. 2013 May;30(5):512-24
pubmed: 23323988
Diabetes Care. 2014 Feb;37(2):402-8
pubmed: 24041677
Diabetes Res Clin Pract. 2014 Feb;103(2):161-75
pubmed: 24331235
Pediatrics. 2014 Apr;133(4):e938-45
pubmed: 24685959
JAMA. 2014 May 7;311(17):1778-86
pubmed: 24794371
Pediatr Clin North Am. 2015 Aug;62(4):857-71
pubmed: 26210621
Diabetes Care. 2015 Oct;38(10):1876-82
pubmed: 26283737
Health Aff (Millwood). 2016 Oct 1;35(10):1816-1824
pubmed: 27702954
Diabetes Care. 2017 Jan;40(Suppl 1):S105-S113
pubmed: 27979899
JAMA Intern Med. 2017 Mar 1;177(3):358-368
pubmed: 28097328
MMWR Morb Mortal Wkly Rep. 2017 May 19;66(19):502-505
pubmed: 28520705
Diabet Med. 2018 Jan;35(1):12-32
pubmed: 28945942