Characterizing social and policy determinants of hospital length of stay among paediatric inpatients with diabetes using linked population-based data.

Heather Higgins,Neeru Gupta

doi:10.23889/ijpds.v6i1.1678

Abstract

BackgroundEvidence is limited on the non-medical factors influencing hospital length of stay (LOS) among paediatric inpatients with diabetes, notably potential social and policy correlates. This study aimed to characterize the associations of socioeconomic status and health policy environment with diabetes-attributable LOS to help inform accountability monitoring of a provincial comprehensive diabetes strategy aiming to minimize time in hospital among this high-risk population.Data and methodsThis retrospective population-based study drew on multiple linked administrative and geospatial databases among all children aged 18 and under with a diabetes-related hospitalization in the province of New Brunswick, Canada, during the four-year period following implementation of an insulin pump funding program. Multiple linear regression was used to assess the role of access to the public insulin pump resourcing scheme and relative neighbourhood deprivation as predictors of days spent in acute care, controlling for age, sex, and place of residence.ResultsAmong the paediatric inpatient population (N = 386), 21% had accessed social resources made available through the insulin pump funding policy and 42% resided in the most materially deprived neighbourhoods. Diabetes-related hospital stays averaged 3.87 days. Paediatric inpatients having accessed resources through the social insurance policy spent significantly fewer days in hospital (1.34 days less [95% CI: 0.63–2.05]) than those who had not, all else being equal. Observed differences in LOS by neighbourhood socioeconomic deprivation were not found to be statistically significant in the multivariate analysis.ConclusionFindings from this context of universal medical coverage suggested that public policy for supplemental financing of assistive technologies among children with diabetes may be associated with reduced burden to the hospital system. The causes of socioenvironmental disparities in LOS require further investigation to inform interventions to mitigate preventable patient-level variations in hospital-based health outcomes.

Highlights

Type 1 diabetes mellitus (T1D), a chronic endocrine disorder most often diagnosed in childhood or adolescence, is primarily managed at the individual, family, and community levels but has important implications for the hospital system [1,2,3,4]
To better inform policy and planning options aimed at minimizing time in hospital among the high-risk paediatric population, the objective of this research was to assess the associations of socioeconomic status and a public insulin pump funding policy with diabetes-related length of stay (LOS) among paediatric inpatients
Based on provincial estimates of diabetes prevalence among children and adolescents [22], this translated to approximately 15.1 hospitalizations per 100 person-years in the paediatric population living with diabetes

Summary

Introduction

Type 1 diabetes mellitus (T1D), a chronic endocrine disorder most often diagnosed in childhood or adolescence, is primarily managed at the individual, family, and community levels but has important implications for the hospital system [1,2,3,4]. Hospital length of stay (LOS) is considered a salient metric of health system costs and performance and may indicate different medical and non-medical factors, such as hospital characteristics, severity of complications, and continuity of care; research on social determinants of LOS is fragmented and incomplete [15,16,17]. Evidence is limited on the non-medical factors influencing hospital length of stay (LOS) among paediatric inpatients with diabetes, notably potential social and policy correlates. This retrospective population-based study drew on multiple linked administrative and geospatial databases among all children aged 18 and under with a diabetes-related hospitalization in the province of New Brunswick, Canada, during the four-year period following implementation of an insulin pump funding program. Multiple linear regression was used to assess the role of access to the public insulin pump resourcing scheme and relative neighbourhood deprivation as predictors of days spent in acute care, controlling for age, sex, and place of residence

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