Abstract

ObjectivesTo examine the temporal patterns of hospitalizations with diabetic ketoacidosis (DKA) in the pediatric population and their associated fiscal impact.MethodsThe Texas Inpatient Public Use Data File was used to identify hospitalizations of state residents aged 1month-19 years with a primary diagnosis of DKA during 2005–2014. Temporal changes of population-adjusted hospitalization rates and hospitalization volumes were examined for the whole cohort and on stratified analyses of sociodemographic attributes. Changes in the aggregate and per-hospitalization charges were assessed overall and on stratified analyses.ResultsThere were 24,072 DKA hospitalizations during the study period. The population-adjusted hospitalization rate for the whole cohort increased from 31.3 to 35.9 per 100,000 between 2005–2006 and 2013–2014. Hospitalization volume increased by 30.2% over the same period, driven mainly by males, ethnic minorities, those with Medicaid insurance and uninsured patients. The aggregate hospital charges increased from approximately $69 million to $130 million between 2005–2006 and 2013–2014, with 66% of the rise being due to increased per-hospitalization charges.ConclusionsThere was progressive rise in pediatric DKA hospitalizations over the last decade, with concurrent near-doubling of the associated fiscal footprint. Marked disparities were noted in the increasing hospitalization burden of DKA, born predominantly by racial and ethnic minorities, as well as by the underinsured and the uninsured. Further studies are needed to identify scalable preventive measures to achieve an equitable reduction of pediatric DKA events.

Highlights

  • The incidence of pediatric diabetes is increasing in the United States (US) [1]

  • Hospitalization volume increased by 30.2% over the same period, driven mainly by males, ethnic minorities, those with Medicaid insurance and uninsured patients

  • There was progressive rise in pediatric Diabetes ketoacidosis (DKA) hospitalizations over the last decade, with concurrent near-doubling of the associated fiscal footprint

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Summary

Introduction

No recent data were reported, to our knowledge, on pediatric diabetes associated hospitalizations in the US, a report by Witt and colleagues documented nearly 28% reduction in the rate of pediatric hospitalizations with a Major Diagnostic Category (MDC) of Endocrine, nutritional and metabolic diseases between 2000 and 2012 [3]. This later downtrend was part of a broader reduction in hospitalization rates for most MDCs [3] and a documented decrease in both volumes and rates of pediatric hospitalizations in the US [4]. The health-related [17] and economic tolls [18] of DKA extend beyond hospital discharge

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