Association of socioeconomic status and hospital efficiency in Type-1 diabetic patients with ketoacidosis or diabetic coma: a secondary data analysis comparing nation-wide paediatric and adult admissions in France

Association entre le statut socio-économique et l'efficience hospitalière chez les patients atteints de diabète de type 1 admis pour acidocétose ou coma diabétique: une analyse secondaire des données nationales comparant les admissions pédiatriques et adultes en France

Yuanchen Xu (), Karine Chevreul (), Christel Dindorf (), Élise Bismuth (), Jean-Claude Carel () and Morgane Michel ()
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Yuanchen Xu: ECEVE (U1123 / UMR_S_1123) - Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables - INSERM - Institut National de la Santé et de la Recherche Médicale - AP-HP Hôpital universitaire Robert-Debré [Paris] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - UPCité - Université Paris Cité
Karine Chevreul: ECEVE (U1123 / UMR_S_1123) - Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables - INSERM - Institut National de la Santé et de la Recherche Médicale - AP-HP Hôpital universitaire Robert-Debré [Paris] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - UPCité - Université Paris Cité, F-75019 Paris - APHP, Hôpital Robert Debré, Service de santé publique, équipe REPERES
Christel Dindorf: ECEVE (U1123 / UMR_S_1123) - Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables - INSERM - Institut National de la Santé et de la Recherche Médicale - AP-HP Hôpital universitaire Robert-Debré [Paris] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - UPCité - Université Paris Cité, F-75019 Paris - APHP, Hôpital Robert Debré, Service de santé publique, équipe REPERES
Élise Bismuth: Service d'Endocrinologie et Diabétologie Pédiatriques - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Robert Debré - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
Jean-Claude Carel: Service d'Endocrinologie et Diabétologie Pédiatriques - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Robert Debré - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP), NeuroDiderot (UMR_S_1141 / U1141) - Maladies neurodéveloppementales et neurovasculaires - INSERM - Institut National de la Santé et de la Recherche Médicale - UPCité - Université Paris Cité
Morgane Michel: ECEVE (U1123 / UMR_S_1123) - Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables - INSERM - Institut National de la Santé et de la Recherche Médicale - AP-HP Hôpital universitaire Robert-Debré [Paris] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - UPCité - Université Paris Cité, F-75019 Paris - APHP, Hôpital Robert Debré, Service de santé publique, équipe REPERES

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Abstract: Aims: To study the association between socioeconomic status (SES) and hospital efficiency in Type 1 diabetes mellitus patients admitted for ketoacidosis or diabetic coma in mainland France, overall and in adults versus children.Methods: An observational study was carried out using exhaustive national hospital discharge databases. It included all admissions discharged from 2013 to 2019. SES was assessed using an ecological measure divided into national quintiles, and efficiency by variations in patients' length of stay (LOS) compared to mean national LOS and a comparison of production costs and revenues. Multilevel multivariable analyses were carried out to study the association. Results: 67,100 admissions were included. Multivariable analyses found a significant association between efficiency outcomes, SES and age. Compared to other age groups, children under 5 had higher LOS than the national mean and incurred higher costs than what hospitals were paid regardless of SES. In adults, there was a significant interaction between SES and age group, leading to significantly increased LOS and costs in adults from intermediate and/or lower SES groups. Conclusions: Current payment methods using diagnosis-related groups may not adequately reflect the burden of Type 1 diabetes mellitus patients admitted for ketoacidosis or diabetic coma on hospitals.

Keywords: Costs and cost analysis; Social deprivation; Length of stay; Diabetic ketoacidosis; Type 1 diabetes mellitus (search for similar items in EconPapers)
Date: 2025-09-04
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Published in Diabetes Research and Clinical Practice, 2025, 229, pp.112450. ⟨10.1016/j.diabres.2025.112450⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-05285904

DOI: 10.1016/j.diabres.2025.112450

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