Is the Frequency of Ketoacidosis at Onset of Type 1 Diabetes a Child Health Indicator That is Related to Income Inequality?

Abstract

A recently published systematic review identifies a number of patient-, family-, physician-, and disease-related factors that account for the presence of diabetic ketoacidosis (DKA) at the onset of disease in children and youth (1). We propose a unifying hypothesis for these factors that the frequency of DKA at disease onset may be related to income inequality. Income inequality is defined as the difference in average incomes between a nation's highest and lowest income earners (2). Wilkinson and Pickett (2) have provided compelling evidence that income inequality is a major determinant of health and social outcomes in the world's most advanced countries. Health indicators such as infant mortality and low birth weight have been found to be less favorable in nations where income inequality is greater (2). We …