O3237: Hospital outcomes in children with diabetic ketoacidosis: the role of social determinants of health and child opportunity index

Background: Diabetic ketoacidosis (DKA) in patients with Type I Diabetes Mellitus is an emergency associated with social drivers of health. Previous studies have shown increase readmission for DKA in patients with lower social economic status and Child Opportunity Index (COI). Our study looks for correlation between Child Opportunity Index and length of stay and complications from DKA in patients admitted to the hospital.

Methods: Children aged ≤18 years with a primary diagnosis of DKA and Type 1 and Diabetes Mellitus were identified using the Pediatric Health Information Systems (PHIS) database from January 2017 to December 2024 based on ICD-10 codes. The primary covariate of interest was the Child Opportunity Index, categorized into five levels: Very Low, Low, Medium, High, and Very High. The primary outcome was hospital readmission rate, while secondary outcomes included length of hospital stay and DKA-related complications such as cerebral edema.

Results: A total of 74,882 pediatric patients were included across all Child Opportunity Index (COI) levels. After adjusting for age categories, sex, race, insurance type, and the presence of complex chronic conditions, regression analysis was performed on 41,204 index hospitalizations to evaluate risk of readmission. Compared to children in the lowest COI level (COI-1), those in higher COI levels had progressively lower odds of readmission: COI-2 (β = –0.09, p < 0.01), COI-3 (β = –0.18, p < 0.01), COI-4 (β = –0.21, p < 0.01), and COI-5 (β = –0.40, p < 0.001). (Figure 1). Similarly, children from higher COI areas had shorter lengths of stay: COI-2 (β = –0.02, p < 0.01), COI-3 (β = –0.05, p < 0.01), COI-4 (β = –0.06, p < 0.01), and COI-5 (β = –0.04, p < 0.01). No significant association was found between COI and the rate of DKA complications such as cerebral edema.

Conclusion: Our findings showed a statistically significant association between higher COI and lower readmission rates , as well as shorter hospital length of stay in patients with T1DM hospitalized with DKA. These results highlight the impact of neighborhood-level social determinants of health on diabetes outcomes. It is hypothesized that this may be due to barriers to optimal diabetes care, including access to continuous glucose monitoring, insulin pumps, and affordable injectable insulin. No significant correlation was found between COI and serious complications such as cerebral edema. Addressing disparities in social opportunity may be a key component in improving outcomes and reducing healthcare utilization in children with T1DM.