The Incidence of Diabetic Ketoacidosis During “Emerging Adulthood” in the USA and Canada: a Population-Based Study
As children with diabetes transition to adulthood, they may be especially vulnerable to diabetic ketoacidosis (DKA). Cross-national comparisons may inform efforts to avoid this complication.
To compare DKA hospitalization rates in the USA and Manitoba, Canada, during the vulnerable years known as “emerging adulthood.”
Cross-sectional study using inpatient administrative databases in the USA (years 1998–2014) and Manitoba, Canada (years 2003–2013).
Individuals aged 12–30 years hospitalized with DKA, identified using ICD-9 (USA) or ICD-10 codes (Manitoba).
DKA hospitalization rates per 10,000 population by age (with a focus on those aged 15–17 vs. 19–21). Admissions were characterized by gender, socioeconomic status, year of hospitalization, and mortality during hospitalization.
The DKA rate was slightly higher in the USA among those aged 15–17: 4.8 hospitalizations/10,000 population vs. 3.7/10,000 in Manitoba. Among those aged 19–21, the DKA hospitalization rate rose 90% in the USA to 9.2/10,000, vs. 23% in Manitoba, to 4.5/10,000. In both the USA and Manitoba, rates were higher among those from poorer areas, and among adolescent girls compared with adolescent boys. DKA admissions rose gradually during the period under study in the USA, but not in Manitoba.
In years of “emerging adulthood,” the Canadian healthcare system appears to perform better than that of the USA in preventing hospitalizations for DKA. Although many factors likely contribute to this difference, universal and seamless coverage over the lifespan in Canada may contribute.
KEY WORDShealthcare access diabetic ketoacidosis, emerging adulthood
The authors acknowledge Carole Taylor for her analysis of the Manitoba data.
The Manitoba researchers were supported through a contract with the Manitoba Government. Dr. Christopher received funding support from an Institutional National Research Service Award (T32HP12706) and the Ryoichi Sasakawa Fellowship Fund.
Compliance with Ethical Standards
Conflict of Interest
The authors report no conflicts of interest with any relevant commercial entities. Drs. Gaffney, McCormick, Himmelstein, and Woolhandler are leaders of Physicians for a National Health Program, a non-profit organization that favors coverage expansion through a single-payer program, and Drs. Bor and Christopher are members of that organization. None of them receive any compensation from that group. Although Adam Gaffney is reimbursed for some of his travel on behalf of the organization. Dr. Katz is supported through the Manitoba Health Research Council Chair in Primary Prevention.
The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Manitoba Population Research Data Repository under project no. 2014-028 (HIPC no. 2014/2015 - 39). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Seniors and Active Living, or other data providers is intended or should be inferred. Data used in this study are from the Manitoba Population Research Data Repository housed at the Manitoba Centre for Health Policy, University of Manitoba, and were derived from data provided by Manitoba Health, Seniors and Active Living.
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