OBJECTIVE: We sought to determine whether census tract poverty, race, and insurance status were associated with the likelihood and severity of diabetic ketoacidosis (DKA) hospitalization among youth with type 1 diabetes (T1D).

METHODS: We conducted a retrospective population-based cohort study using Cincinnati Children’s Hospital electronic medical record (EMR) data from January 1, 2011, to December 31, 2017, for T1D patients ≤18 years old. The primary outcome was admission for DKA. Secondary outcomes included DKA severity, defined by initial pH and bicarbonate, and length of stay. Exposures were the poverty rate for the youth’s home census tract, parent-reported race, and insurance status. We used multivariable logistic regression to analyze effects on odds of admission.

RESULTS: We identified 439 patients with T1D; 152 were hospitalized. The cohort was 48% female, 25% Black, and 36% publicly insured; the median age was 14 years. For every 10% increase in a youth’s census tract poverty rate, the adjusted odds of admission increased by 22% (95% CI, 1.03-1.47). Public insurance status was associated with DKA admission (adjusted odds ratio [AOR], 2.71, 95% CI, 1.62-4.55) while race was not. There were no clinically meaningful differences in pH or bicarbonate by census tract poverty, race, or insurance status; however, Black patients experienced differences in care (eg, longer length of stay).

CONCLUSION: Youth with T1D living in high poverty areas and on public insurance were significantly more likely to be admitted for DKA. Severity upon presentation was similar across exposures. Understanding contextual mechanisms by which disparities emerge will inform changes aimed at equitably improving care.

目的：我们试图确定人口普查区贫困、种族和保险状况是否与 1 型糖尿病 (T1D) 青年患者发生糖尿病酮症酸中毒 (DKA) 住院的可能性和严重程度相关。

方法：我们使用辛辛那提儿童医院电子病历 (EMR) 数据从 2011 年 1 月 1 日至 2017 年 12 月 31 日对 18 岁以下的 T1D 患者进行了一项基于人群的回顾性队列研究。主要结局是因 DKA 入院。次要结果包括 DKA 严重程度（由初始 pH 值和碳酸氢盐定义）以及住院时间。暴露是青年家庭人口普查区的贫困率、父母报告的种族和保险状况。我们使用多变量逻辑回归来分析对入院几率的影响。

结果：我们确定了 439 名 T1D 患者；152人住院。该队列中有 48% 的女性、25% 的黑人和 36% 的公共保险；中位年龄为 14 岁。青年人口普查区贫困率每增加 10%，调整后的录取几率就会增加 22%（95% CI，1.03-1.47）。公共保险状态与 DKA 入院有关（调整后的优势比 [AOR]，2.71，95% CI，1.62-4.55），而种族则没有。人口普查区贫困、种族或保险状况在 pH 值或碳酸氢盐方面没有临床意义的差异；然而，黑人患者在护理方面存在差异（例如，住院时间更长）。

结论：生活在高贫困地区和有公共保险的 T1D 青年被 DKA 录取的可能性要大得多。暴露时的严重程度相似。了解差异出现的背景机制将为旨在公平改善护理的变化提供信息。