medwireNews: Young people with type 1 diabetes are at increased risk for hospitalization for acute complications at the time of transition from pediatric to adult care, say researchers.
And this was particularly the case for Black people with low socioeconomic status, report Angel Siu Ying Nip and Maya Lodish, both from the University of California in San Francisco, USA.
“Our findings suggest that the U.S. health care system fails many emerging adults with diabetes, particularly for people of color, and that improving the medical transition is crucial,” they write in Diabetes Care.
“More resources should be focused on this at-risk population from a healthcare system perspective.”
Using hospital data for California in 2014–2018, the researchers identified 38,053 admissions for diabetic ketoacidosis or severe hypoglycemia in young people aged 13–24 years. The majority of these people had type 1 diabetes, but there were also 3304 admissions involving people with type 2 diabetes.
The admission rate was relatively stable between the ages of 13 and 16 years. But there was then a sharp increase among people with type 1 diabetes across the transition period age, from 22.9% of admissions among those aged 17 years to 43.0% of admissions among 19-year-olds. Thereafter, the rate remained high, but relatively stable.
By contrast, admission rates in people with type 2 diabetes stayed relatively constant with age, with no obvious change across the transition age.
At all ages, the hospital admission rates for people with type 1 diabetes were “disproportionately higher” for Black than White study participants, at 23.9% versus 3.4% of admissions among young adults (19–24 years) and 12.0% versus 1.8% of admissions among youths (13–18 years). The rate in Black young adults was significantly higher than that in Black youths.
Young adults in general had a higher rate of moderate or severe illness than the youths did, and their hospital costs were higher, and this was true for both type 1 and type 2 diabetes.
The young adults in both groups were more likely than the youths to have public health insurance, at 64.0% versus 45.1% for those with type 1 diabetes and 68.4% versus 50.4% for those with type 2 diabetes. Moreover, in the type 2 diabetes group, five times more young adults than youths were uninsured, at 4.1% versus 0.8%.
And for both diabetes types and both age groups, the largest proportion of the hospitalizations was accounted for by people in the lowest income quartile. For example, 40.0% of youths with type 1 diabetes were in this quartile, whereas just 13.8% were in the highest quartile.
“The disparity widened after age 18, implicating socioeconomic factors as important contributors to the rising trend,” observe the researchers.
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