SUN-851 - Increased National Admission Rates and Mortality for Diabetic Ketoacidosis during the COVID-19 Pandemic

Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus that is responsible for over 100,000 annual hospital admissions in the United States. There is limited data investigating the effect of the COVID-19 pandemic on epidemiologic trends and disparities in outcomes for hospitalizations for DKA.
The National Inpatient Sample (NIS) database from 2016 to 2020 was searched for hospitalizations of adult patients with DKA as a principal diagnosis using the International Classification of Diseases Codes, tenth revision (ICD-10) - E.10.10, E10.11, E11.10 and E11.1. The crude admission rate was calculated by dividing total DKA hospitalizations as the principal diagnosis by the total adult hospitalizations for each calendar year studied and expressed per 1000 hospitalizations. Multivariable regression analysis was utilized to calculate the adjusted admission and mortality rates adjusted for age categories, sex, race, and grouped Charlston Comorbidity Index, utilizing predictive margins. The primary outcome was a comparison of adjusted inpatient mortality rates, and the secondary outcomes were the length of hospital stay and total hospital charge between prepandemic and pandemic years.
A total of 193,060 admissions were identified for DKA between 2016-2020. During the pandemic (2020), the adjusted admission rate for DKA was 7.08 admissions per 1000 adults hospitalized compared to 6.38 admissions in 2019 (prepandemic) (p value < 0.001). When compared to the prepandemic admissions, those admitted during the pandemic had less females (46.7% vs 48.3%, p< 0.001) and Whites (53.5% vs 56.2%, p=0.02). The inpatient mortality during the pandemic was significantly higher with 0.52% compared to 0.42% (p=0.02). Mortality increased in males (0.60% vs 0.39%, p< 0.001), Blacks (0.42% vs 0.55%, p=0.02), Hispanics (0.46% vs 0.24%, p< 0.001), Quartile 1 (0.49% vs 0.38%, p=0.01) and Northeast region (0.83% vs 0.49%, p< 0.001). There was an statistically significant increase in length of stay (3.98 vs 3.18 days, p=0.001) and mean total hospital charge ($36,794 vs $33,989, 0 < 0.001) during the pandemic when compared to the prepandemic year.
In conclusion, our study showed a statistically significant increase in DKA admission rates, mortality, length of stay and mean total hospital charges during the pandemic. These findings may be related to poor access to healthcare/medications, increased triggers for ketoacidosis such as infection and overall “strain” of COVID-19 pandemic on healthcare in the United States.

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