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

BACKGROUND AND OBJECTIVES: Diabetic ketoacidosis (DKA) rates in the US 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 (KID) to identify pediatric DKA admissions among a nationally-representative sample of admissions 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, while 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 18-20 year-old, females, Black youth, without private insurance, with lower incomes, and from non-urban areas. Young adults, men, those without private insurance, and from non-urban areas had greater increases in DKA rates across time.

CONCLUSIONS: Pediatric DKA admissions have risen by 40% in the US 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.