Increased risk of diabetic ketoacidosis in an Urban, United States, safety-net emergency department in the COVID-19 era

Elizabeth Burner; Lucy Liu; Sophie Terp; Sanjay Arora; Chun Nok Lam; Michael Menchine; Daniel A Dworkis; Sarah Axeen; Elizabeth Burner; Lucy Liu; Sophie Terp; Sanjay Arora; Chun Nok Lam; Michael Menchine; Daniel A Dworkis; Sarah Axeen

doi:10.3934/medsci.2023004

AIMS Medical Science

2023, Volume 10, Issue 1: 37-45. doi: 10.3934/medsci.2023004

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Research article Topical Sections

Increased risk of diabetic ketoacidosis in an Urban, United States, safety-net emergency department in the COVID-19 era

1.
Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, 1200 N State St, Los Angeles, CA 90033, USA
2.
Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA 90089, USA
3.
Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA

Received: 19 September 2022 Revised: 24 January 2023 Accepted: 12 February 2023 Published: 24 February 2023

Aims
The incidence of diabetic ketoacidosis (DKA) increased during the COVID-19 pandemic but estimates from low-resource settings are limited. We examined the odds of DKA among emergency department (ED) visits in the Los Angeles County Department of Health Services (DHS) (1) during the COVID-19 pandemic compared to the pre-COVID era, (2) without active COVID infections, and (3) stratified by effect modifiers to identify impacted sub-groups.

Methods
We estimated the odds of DKA from 400,187 ED visits pre-COVID era (March 2019–Feb 2020) and 320,920 ED visits during the COVID era (March 2020–Feb 2021). Our base model estimated the odds of DKA based on the COVID era. Additional specifications stratified by effect modifiers, controlled for confounders, and limited to visits without confirmed COVID-19 disease.

Results
After adjusting for triage acuity and interaction terms for upper respiratory infections and payor, the odds of DKA during the COVID era were 27% higher compared to the pre-COVID era (95%CI 14–41%, p < 0.001). In stratified analyses, visits with private payors had a 112% increased odds and visits with Medicaid had a 20% increased odds of DKA during the COVID era (95%CI 7–36%, p = 0.003).

Conclusions
We identified increased odds of DKA during the COVID pandemic, robust to a variety of specifications. We found differential effects by the payor; with increased odds during COVID for privately-insured patients.
- DKA,
- emergency department,
- COVID-19,
- pandemic,
- insurance,
- access to care
Citation: Elizabeth Burner, Lucy Liu, Sophie Terp, Sanjay Arora, Chun Nok Lam, Michael Menchine, Daniel A Dworkis, Sarah Axeen. Increased risk of diabetic ketoacidosis in an Urban, United States, safety-net emergency department in the COVID-19 era[J]. AIMS Medical Science, 2023, 10(1): 37-45. doi: 10.3934/medsci.2023004

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Abstract

Aims

The incidence of diabetic ketoacidosis (DKA) increased during the COVID-19 pandemic but estimates from low-resource settings are limited. We examined the odds of DKA among emergency department (ED) visits in the Los Angeles County Department of Health Services (DHS) (1) during the COVID-19 pandemic compared to the pre-COVID era, (2) without active COVID infections, and (3) stratified by effect modifiers to identify impacted sub-groups.

Methods

We estimated the odds of DKA from 400,187 ED visits pre-COVID era (March 2019–Feb 2020) and 320,920 ED visits during the COVID era (March 2020–Feb 2021). Our base model estimated the odds of DKA based on the COVID era. Additional specifications stratified by effect modifiers, controlled for confounders, and limited to visits without confirmed COVID-19 disease.

Results

After adjusting for triage acuity and interaction terms for upper respiratory infections and payor, the odds of DKA during the COVID era were 27% higher compared to the pre-COVID era (95%CI 14–41%, p < 0.001). In stratified analyses, visits with private payors had a 112% increased odds and visits with Medicaid had a 20% increased odds of DKA during the COVID era (95%CI 7–36%, p = 0.003).

Conclusions

We identified increased odds of DKA during the COVID pandemic, robust to a variety of specifications. We found differential effects by the payor; with increased odds during COVID for privately-insured patients.

Funding

Dr. Burner's time for this project was partially supported by a grant from the NIDDK K23DK106538.

Conflict of interest

The authors confirm that there are no conflicts of interest in this article's content.

References

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