Regional Deprivation and Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis in Children and Adolescents: International Comparison among 6 Countries
Authors' conclusion
Deprivation was significantly associated with the risk of DKA at the diagnosis of type 1 diabetes, and DKA was more common during the pandemic years 2020-2022 than in 2019. Younger children appear to be more vulnerable to deprivation than older patients. Understanding and reducing local and demographic-specific disparities are essential for effective intervention.
Study context
- Population
- Children 0.5–17.0 years diagnosed with T1D 2019–2022 in 6 diabetes registries; mean age 9.08 (SD 4.19) years
- Participants
- 21,020 children
- Exposure
- Standardized regional deprivation index and diabetic ketoacidosis (DKA) at T1D diagnosis
- Germanyn = 13,561
- Italyn = 4,659
- Colorado, USAn = 1,318
- Walesn = 769
- New Zealandn = 407
- Slovenian = 306
- Outcome
- DKA at T1D diagnosis, association with standardized deprivation index (adjusted for sex, age group, year)
Methodological detailsinternational, 6 diabetes registries, log-binomial regression
- International
- 6 diabetes registries
- Log-binomial regression
Main finding
As reported in the abstract
Overall DKA rate
36.5%
Deprivation and DKA risk, age 0.5-<6 years: OR
1.16 (1.10-1.23), p < 0.0001 (95% CI)
Deprivation and DKA risk, age 6-<12 years: OR
1.05 (1.05-1.11), p = 0.02 (95% CI)
Observational data: associations, not effects.
Further findings
| Outcome | Values |
|---|---|
| DKA rate by country | Germany 32.5% · Italy 42.5% · Colorado, USA 54.9% · Wales 35.2% · New Zealand 43.7% · Slovenia 37.6% |
Female sex and DKA risk
- Female sex increased DKA risk: OR
- 1.06 (1.00-1.13), p = 0.04 (95% CI)
DKA by year
- DKA proportion lower in 2019 than in 2020, 2021 and 2022
- each p < 0.0001
Original publication
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