Association of Neighborhood Resources and Race and Ethnicity With Readmissions for Diabetic Ketoacidosis at US Children’s Hospitals

Bergmann, Kelly R.; Nickel, Amanda; Hall, Matt; Cutler, Gretchen J.; Abuzzahab, M. Jennifer; Bretscher, Brianna; Lammers, Shea; Watson, Dave; Hester, Gabrielle

doi:10.1001/jamanetworkopen.2022.10456

Cited by 18 publications

(11 citation statements)

References 72 publications

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“…We found that most ketoacidosis admissions occurred 3 months or more after diabetes diagnosis, suggesting many of these hospitalisations could be prevented by better community management of young people after diagnosis of type 1 diabetes. We found that one quarter of those admitted for ketoacidosis had a recurrent admission for ketoacidosis within a 12‐month period, and that readmissions were most common in those residing in areas of highest socio‐economic disadvantage, which is consistent with findings from a recent study of US youth with type 1 diabetes 26 . Our findings suggest that clinicians and policymakers should consider targeted management and resource allocation towards areas of highest socio‐economic disadvantage where youth with type 1 diabetes may be predisposed to ketoacidosis admission and readmission.…”

Section: Discussionsupporting

confidence: 90%

“…We found that one quarter of those admitted for ketoacidosis had a recurrent admission for ketoacidosis within a 12-month period, and that readmissions were most common in those residing in areas of highest socio-economic disadvantage, which is consistent with findings from a recent study of US youth with type 1 diabetes. 26 Our findings suggest that clinicians and policymakers should consider targeted management and resource allocation towards areas of highest socio-economic disadvantage where youth with type 1 diabetes may be predisposed to ketoacidosis admission and readmission. Notably, the association between residence in areas of socio-economic disadvantage and hospitalisation was stronger for hyperglycaemia than for hypoglycaemia.…”

Section: Relative Risk Of Hospitalisation (95% Ci)mentioning

confidence: 80%

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Reasons for hospitalisation in youth with type 1 diabetes, 2010–2019

Tomic,

Craig,

Magliano

et al. 2023

Diabet Med

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AimsTo determine the incidence of hospitalisation for all diagnoses among Australian youth with type 1 diabetes.MethodsWe linked Australians aged under 20 years with type 1 diabetes on the National Diabetes Services Scheme (n = 45,685) to hospital admission data from 2010 to 2019. We determined relative risks (RR) of hospitalisation among those with type 1 diabetes in the states of Victoria and Queensland (n = 21,898) compared to the general population for 2010–2017 using Poisson regression.ResultsAustralian youth with type 1 diabetes had increased risk for almost all reasons for hospitalisation compared to the general population, especially infections such as anogenital herpesviral infections (RR 54.83, 95% CI 33.21–90.53), and mental health disorders including personality disorders (RR 9.70, 95% CI 8.02–11.72). Among those with type 1 diabetes, over 60% of hospitalisations were directly related to diabetes, almost half of which were for ketoacidosis. Approximately 15% of ketoacidosis admissions occurred within 3 months of diabetes diagnosis. One quarter of those with admissions for ketoacidosis were readmitted for ketoacidosis within 12 months. Residence in areas of high socio‐economic disadvantage was an independent risk factor for admission and readmission for ketoacidosis.ConclusionsYouth with type 1 diabetes are susceptible to a wide range of complications. Clinicians should consider screening and prevention for conditions such as infections and mental health disorders. Targeted support and education around glycaemic management should be considered in those at high risk for ketoacidosis admission including those living in areas of high socio‐economic disadvantage.

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Section: Discussionsupporting

confidence: 90%

Section: Relative Risk Of Hospitalisation (95% Ci)mentioning

confidence: 80%

Reasons for hospitalisation in youth with type 1 diabetes, 2010–2019

Tomic,

Craig,

Magliano

et al. 2023

Diabet Med

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“…A recently developed neighborhood-level index, Child Opportunity Index (COI), has emerged as a promising indicator of adverse health outcomes in youth, including obesity,7 recurrent diabetic ketoacidosis (DKA) in youth with T1D,8 and potentially avoidable hospitalization 9. This composite index, developed in 2014 and revised in 2020 to version 2.0, is available for nearly all census tracts within the USA and encompasses 29 measures of neighborhood-level resources influencing pediatric health and development, including but not limited to access to high-quality schools, healthy foods, green space, and toxin-free environments 10–12.…”

Section: Introductionmentioning

confidence: 99%

Child Opportunity Index and clinical characteristics at diabetes diagnosis in youth: type 1 diabetes versus type 2 diabetes

Hoyek,

Libman,

Mkparu

et al. 2024

BMJ Open Diab Res Care

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IntroductionAmong youth with type 1 diabetes (T1D), longitudinal poor glycemic control is associated with adverse socioeconomic conditions at the neighborhood level. Child Opportunity Index (COI), which encompasses measures of education, health, environment, social, and economic factors, is associated with obesity in youth but has not been evaluated in youth with new-onset T1D or type 2 diabetes (T2D). We hypothesized that lower COI would be associated with adverse clinical outcomes at diabetes diagnosis, and due to differing risk factors and pathophysiology, that youth with new-onset T2D would have lower COI than youth with T1D.Research design and methodsRetrospective cohort of youth with new-onset diabetes admitted to a large academic pediatric hospital. COI was compared by diabetes type using t-tests and Χ2tests. Multivariable linear and logistic regression analyses were used to evaluate associations between COI and clinical characteristics, stratified by diabetes type and adjusted for age and sex.ResultsThe cohort (n=484) differed in race and age by diabetes type (T1D: n=389; 10.0% black, 81.2% white; age 9.6±0.2 years; T2D: n=95; 44.2% black, 48.4% white; age 14.8±0.3 years). Youth with T2D had lower COI (p<0.001). Low COI was associated with diabetic ketoacidosis in T1D and T2D. Black youth with low COI had the highest hemoglobin A1c among youth with T2D and the highest obesity prevalence among youth with T1D.ConclusionsCOI is associated with differing characteristics at diagnosis in youth-onset T1D and T2D but is worse among youth with T2D overall. These findings underscore the need to address socioeconomic adversity when designing interventions to reduce T2D risk and to improve outcomes at diabetes diagnosis in youth.

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“…17 Neighborhood opportunity for children has been associated with health outcomes in children, including hospitalizations, acute care visits, infant health, mental health, and cardiometabolic risk factors. [18][19][20][21][22][23][24][25][26] Interventions to improve life expectancy in socially vulnerable populations are challenging but possible. To develop interventions, we must first better understand the associations between life expectancy and community-level factors.…”

Section: Introductionmentioning

confidence: 99%

“…The social and environmental conditions in which people live likely account for part of the association between neighborhood poverty and health . Neighborhood opportunity for children has been associated with health outcomes in children, including hospitalizations, acute care visits, infant health, mental health, and cardiometabolic risk factors …”

Section: Introductionmentioning

confidence: 99%

Association of Neighborhood Conditions and Resources for Children With Life Expectancy at Birth in the US

et al. 2022

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ImportanceTo address inequities in life expectancy, we must understand the associations of modifiable socioeconomic and structural factors with life expectancy. However, the association of limited neighborhood resources and deleterious physical conditions with life expectancy is not well understood.ObjectiveTo evaluate the association of community social and economic conditions and resources for children with life expectancy at birth.Design, Setting, and ParticipantsThis cross-sectional study examined neighborhood child opportunity and life expectancy using data from residents of 65 662 US Census tracts in 2015. The analysis was conducted from July 6 to October 1, 2021.ExposuresNeighborhood conditions and resources for children in 2015.Main Outcomes and MeasuresThe primary outcome was life expectancy at birth at the Census tract level based on data from the US Small-Area Life Expectancy Estimates Project (January 1, 2010, to December 31, 2015). Neighborhood conditions and resources for children were quantified by Census tract Child Opportunity Index (COI) 2.0 scores for 2015. This index captures community conditions associated with children’s health and long-term outcomes categorized into 5 levels, from very low to very high opportunity. It includes 29 indicators in 3 domains: education, health and environment, and social and economic factors. Mixed-effects and simple linear regression models were used to estimate the associations between standardized COI scores (composite and domain-specific) and life expectancy.ResultsThe study included residents from 65 662 of 73 057 US Census tracts (89.9%). Life expectancy at birth across Census tracts ranged from 56.3 years to 93.6 years (mean [SD], 78.2 [4.0] years). Life expectancy in Census tracts with very low COI scores was lower than life expectancy in Census tracts with very high COI scores (−7.06 years [95% CI, −7.13 to −6.99 years]). Stepwise associations were observed between COI scores and life expectancy. For each domain, life expectancy was shortest in Census tracts with very low compared with very high COI scores (education: β = −2.02 years [95% CI, −2.12 to −1.92 years]); health and environment: β = −2.30 years [95% CI, −2.41 to −2.20 years]; social and economic: β = −4.16 years [95% CI, −4.26 to −4.06 years]). The models accounted for 41% to 54% of variability in life expectancy at birth (R2 = 0.41-0.54).Conclusions and RelevanceIn this study, neighborhood conditions and resources for children were significantly associated with life expectancy at birth, accounting for substantial variability in life expectancy at the Census tract level. These findings suggest that community resources and conditions are important targets for antipoverty interventions and policies to improve life expectancy and address health inequities.

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Association of Neighborhood Resources and Race and Ethnicity With Readmissions for Diabetic Ketoacidosis at US Children’s Hospitals

Cited by 18 publications

References 72 publications

Reasons for hospitalisation in youth with type 1 diabetes, 2010–2019

Reasons for hospitalisation in youth with type 1 diabetes, 2010–2019

Child Opportunity Index and clinical characteristics at diabetes diagnosis in youth: type 1 diabetes versus type 2 diabetes

Association of Neighborhood Conditions and Resources for Children With Life Expectancy at Birth in the US

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