Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK.
Diabetologia. 2012 Sep;55(9):2356-60. doi: 10.1007/s00125-012-2601-6. Epub 2012 Jun 26.
AIMS/HYPOTHESIS: Diabetic ketoacidosis is a potentially life-threatening complication of diabetes and has a strong relationship with HbA(1c). We examined how socioeconomic group affects the likelihood of admission to hospital for diabetic ketoacidosis.
The Scottish Care Information - Diabetes Collaboration (SCI-DC), a dynamic national register of all cases of diagnosed diabetes in Scotland, was linked to national data on hospital admissions. We identified 24,750 people with type 1 diabetes between January 2005 and December 2007. We assessed the relationship between HbA(1c) and quintiles of deprivation with hospital admissions for diabetic ketoacidosis in people with type 1 diabetes adjusting for patient characteristics.
We identified 23,479 people with type 1 diabetes who had complete recording of covariates. Deprivation had a substantial effect on odds of admission to hospital for diabetic ketoacidosis (OR 4.51, 95% CI 3.73, 5.46 in the most deprived quintile compared with the least deprived). This effect persisted after the inclusion of HbA(1c) and other risk factors (OR 2.81, 95% CI 2.32, 3.39). Men had a reduced risk of admission to hospital for diabetic ketoacidosis (OR 0.71, 95% CI 0.63, 0.79) and those with a history of smoking had increased odds of admission to hospital for diabetic ketoacidosis by a factor of 1.55 (95% CI 1.36, 1.78).
CONCLUSIONS/INTERPRETATION: Women, smokers, those with high HbA(1c) and those living in more deprived areas have an increased risk of admission to hospital for diabetic ketoacidosis. The effect of deprivation was present even after inclusion of other risk factors. This work highlights that those in poorer areas of the community with high HbA(1c) represent a group who might be usefully supported to try to reduce hospital admissions.
目的/假设：糖尿病酮症酸中毒是糖尿病一种潜在的危及生命的并发症，与 HbA(1c) 有很强的关系。我们研究了社会经济群体如何影响因糖尿病酮症酸中毒住院的可能性。
苏格兰护理信息-糖尿病合作组织（SCI-DC）是苏格兰所有确诊糖尿病病例的动态国家登记处，与国家住院数据相链接。我们确定了 2005 年 1 月至 2007 年 12 月期间的 24750 例 1 型糖尿病患者。我们评估了 HbA(1c)与贫困五分位数之间的关系，以及在调整了患者特征后，1 型糖尿病患者因糖尿病酮症酸中毒住院的关系。
我们确定了 23479 例 1 型糖尿病患者，他们的协变量有完整的记录。贫困对因糖尿病酮症酸中毒住院的几率有很大的影响（与最贫困五分位数相比，最贫困五分位数的入院几率为 4.51，95%可信区间为 3.73-5.46）。在纳入 HbA(1c)和其他危险因素后，这种影响仍然存在（OR 2.81，95%可信区间为 2.32-3.39）。男性因糖尿病酮症酸中毒住院的风险降低（OR 0.71，95%可信区间为 0.63-0.79），有吸烟史的人因糖尿病酮症酸中毒住院的几率增加了 1.55 倍（95%可信区间为 1.36-1.78）。
结论/解释：女性、吸烟者、HbA(1c)较高者和生活在贫困地区者因糖尿病酮症酸中毒住院的风险增加。即使在纳入其他危险因素后，贫困的影响仍然存在。这项工作强调，社区中 HbA(1c)较高的贫困地区的人可能需要得到支持，以努力减少住院治疗。
