Sayers Adrian, Thayer Daniel, Harvey John N, Luzio Stephen, Atkinson Mark D, French Robert, Warner Justin T, Dayan Colin M, Wong Susan F, Gregory John W
School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK.
Centre for Health Information Research and Evaluation, College of Medicine, Swansea University, Swansea, UK.
BMJ Open. 2015 Apr 13;5(4):e005644. doi: 10.1136/bmjopen-2014-005644.
To estimate the excess in admissions associated with type1 diabetes in childhood.
Matched-cohort study using anonymously linked hospital admission data.
Brecon Group Register of new cases of childhood diabetes in Wales linked to hospital admissions data within the Secure Anonymised Information Linkage Databank.
1577 Welsh children (aged between 0 and 15 years) from the Brecon Group Register with newly-diagnosed type-1 diabetes between 1999-2009 and 7800 population controls matched on age, sex, county, and deprivation, randomly selected from the local population.
Difference in all-cause hospital admission rates, 30-days post-diagnosis until 31 May 2012, between participants and controls.
Children with type-1 diabetes were followed up for a total of 12,102 person years and were at 480% (incidence rate ratios, IRR 5.789, (95% CI 5.34 to 6.723), p<0.0001) increased risk of hospital admission in comparison to matched controls. The highest absolute excess of admission was in the age group of 0-5 years, with a 15.4% (IRR 0.846, (95% CI 0.744 to 0.965), p=0.0061) reduction in hospital admissions for every 5-year increase in age at diagnosis. A trend of increasing admission rates in lower socioeconomic status groups was also observed, but there was no evidence of a differential rate of admissions between men and women when adjusted for background risk. Those receiving outpatient care at large centres had a 16.1% (IRR 0.839, (95% CI 0.709 to 0.990), p=0.0189) reduction in hospital admissions compared with those treated at small centres.
There is a large excess of hospital admissions in paediatric patients with type-1 diabetes. Rates are highest in the youngest children with low socioeconomic status. Factors influencing higher admission rates in smaller centres (eg, "out of hours resources") need to be explored with the aim of targeting modifiable influences on admission rates.
评估儿童1型糖尿病相关的住院超额情况。
使用匿名链接的医院住院数据进行匹配队列研究。
威尔士儿童糖尿病新病例布雷肯组登记册，与安全匿名信息链接数据库中的医院住院数据相链接。
来自布雷肯组登记册的1577名威尔士儿童（年龄在0至15岁之间），于1999年至2009年间新诊断为1型糖尿病，以及7800名按年龄、性别、郡县和贫困程度匹配的人群对照，从当地人群中随机选取。
参与者与对照在2012年5月31日前诊断后30天内全因住院率的差异。
1型糖尿病患儿共随访12102人年，与匹配对照相比，住院风险增加了480%（发病率比，IRR 5.789，（95%可信区间5.34至6.723），p<0.0001）。住院绝对超额最高的是0至5岁年龄组，诊断时年龄每增加5岁，住院率降低15.4%（IRR 0.846，（95%可信区间0.744至0.965），p=0.0061）。还观察到社会经济地位较低群体住院率上升的趋势，但在调整背景风险后，没有证据表明男性和女性的住院率存在差异。在大型中心接受门诊治疗的患者与在小型中心治疗的患者相比，住院率降低了16.1%（IRR 0.8
