National Trends in Pediatric Admissions for Diabetic Ketoacidosis, 2006-2016

Abstract

Background and objectives: Diabetic ketoacidosis (DKA) rates in the United States are rising. Prior studies suggest higher rates in younger populations, but no studies have evaluated national trends in pediatric populations and differences by subgroups. As such, we sought to examine national trends in pediatric DKA.

Methods: We used the 2006, 2009, 2012, and 2016 Kids' Inpatient Database to identify pediatric DKA admissions among a nationally representative sample of admissions of youth ≤20 years old. We estimate DKA admission per 10 000 admissions and per 10 000 population, charges, length of stay (LOS), and trends over time among all hospitalizations and by demographic subgroups. Regression models were used to evaluate differences in DKA rates within subgroups overtime.

Results: Between 2006 and 2016, there were 149 535 admissions for DKA. Unadjusted DKA rate per admission increased from 120.5 (95% CI, 115.9-125.2) in 2006 to 217.7 (95% CI, 208.3-227.5) in 2016. The mean charge per admission increased from $14 548 (95% CI, $13 971-$15 125) in 2006 to $20 997 (95% CI, $19 973-$22 022) in 2016, whereas mean LOS decreased from 2.51 (95% CI, 2.45-2.57) to 2.28 (95% CI, 2.23-2.33) days. Higher DKA rates occurred among 18- to 20-year-old females, Black youth, without private insurance, with lower incomes, and from nonurban areas. Young adults, men, those without private insurance, and from nonurban areas had greater increases in DKA rates across time.

Conclusions: Pediatric DKA admissions have risen by 40% in the United States and vulnerable subgroups remain at highest risk. Further studies should characterize the challenges experienced by these groups to inform interventions to mitigate their DKA risk and to address the rising DKA rates nationally.

Keywords: diabetic ketoacidosis; disparities; pediatrics; type 1 diabetes.

Figure 1.

Mean hospital charges and length of stay for diabetic ketoacidosis. Unadjusted mean (95% CI) hospital charges in 2016 US dollars and mean (95% CI) length of stay for diabetic ketoacidosis admissions by year, using the Kid’s Inpatient Database. ***Statistical significance <0.001 in the P value for trend across years.

Figure 2.

Adjusted diabetic ketoacidosis prevalence and rate by year and patient characteristics. Figures show adjusted marginal prevalence (left) and adjusted marginal rate (right) of diabetic ketoacidosis (DKA) admissions and associated 95% CIs by patient characteristics and year. Marginal probabilities were output from multivariate models that included interactions between each characteristic and year, and that were adjusted for age, sex, race/ethnicity, payer, urbanicity, income, region, hospital ownership, and hospital bed size. Marginal probabilities were applied to observed hospitalization totals to estimate adjusted prevalence of DKA admissions and were applied to a hypothetical population of 10 000 admissions to estimate adjusted rate of DKA admissions. Not all covariate subgroups are shown. Adjusted annual trend was statistically significant for all subgroups at P < 0.01. Statistically significant differences in the annual trend between subgroups relative to the reference (ref) subgroup (ie, interaction) is noted by asterisks in the legend; *P < 0.05, **P < 0.01, and ***P < 0.001.

Figure 2.

Adjusted diabetic ketoacidosis prevalence and rate by year and patient characteristics. Figures show adjusted marginal prevalence (left) and adjusted marginal rate (right) of diabetic ketoacidosis (DKA) admissions and associated 95% CIs by patient characteristics and year. Marginal probabilities were output from multivariate models that included interactions between each characteristic and year, and that were adjusted for age, sex, race/ethnicity, payer, urbanicity, income, region, hospital ownership, and hospital bed size. Marginal probabilities were applied to observed hospitalization totals to estimate adjusted prevalence of DKA admissions and were applied to a hypothetical population of 10 000 admissions to estimate adjusted rate of DKA admissions. Not all covariate subgroups are shown. Adjusted annual trend was statistically significant for all subgroups at P < 0.01. Statistically significant differences in the annual trend between subgroups relative to the reference (ref) subgroup (ie, interaction) is noted by asterisks in the legend; *P < 0.05, **P < 0.01, and ***P < 0.001.