Published online August 10, 2009
PEDIATRICS Vol. 124 No. 3 September 2009, pp. 926-934 (doi:10.1542/peds.2008-3826)
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ARTICLE

Hospitalization Subsequent to Diagnosis in Young Patients With Diabetes in Chicago, Illinois

Carmela L. Estrada, MPHa, Kirstie K. Danielson, PhDa, Melinda L. Drum, PhDb and Rebecca B. Lipton, PhDa,b

a Institute for Endocrine Discovery and Clinical Care
b Department of Health Studies, University of Chicago, Chicago, Illinois

OBJECTIVES: Rehospitalization after a diabetes diagnosis in youth signals the failure of outpatient management. We examined risk factors for rehospitalization among young patients with diabetes.

PATIENTS AND METHODS: We queried 535 participants diagnosed before 18 years of age from the Chicago Childhood Diabetes Registry. Demographic, social, and clinical data were used in logistic models of diabetes-related rehospitalization, as well as, among those rehospitalized, frequent (≥ once per 2 years' duration) versus infrequent rehospitalization rates.

RESULTS: Mean (range) duration was 5.1 years (0.1–19.2 years). The sample was 55% non-Hispanic black, 11% non-Hispanic white, 26% Hispanic, and 7% other/mixed race; 86% had presumed type 1 diabetes; and 47% were underinsured. Overall, 46% reported rehospitalization for diabetes. In multivariable logistic regression, ever being rehospitalized was significantly associated with diabetes duration (per year, odds ratio [OR]: 1.26; P < .01), female gender (OR: 1.67; P = .01), underinsurance (versus private insurance; OR: 1.79; P < .01), presumed phenotype (non–type 1 diabetes versus type 1; OR: 0.32; P < .01), and diagnosis at a community hospital (versus tertiary care facility; OR: 1.96; P < .01) and tended to be higher for those of nonwhite race (OR: 1.94; P = .07). Among those rehospitalized, multivariable associations with frequent rehospitalization were presumed phenotype (non–type 1 diabetes versus type 1; OR: 2.74; P = .04), head of household not working (versus employed; OR: 1.88; P = .02), and younger age at questionnaire (per year; OR: 0.94; P = .01).

CONCLUSIONS: Rehospitalization is common in young patients with diabetes, especially for those with limited resources, indicating the need for improved outpatient services. Comprehensive initial education and support available to young patients with diabetes diagnosed at tertiary care facilities and their families may have lasting protective effects.

Key Words: hospitalization • diabetes • children • adolescents

Abbreviations: CCDR—Chicago Childhood Diabetes Registry • NHW—non-Hispanic white • NHB—non-Hispanic black • OR—odds ratio

Accepted Mar 10, 2009.


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