PDF(Pubmed)
Abstract：
BACKGROUND: During the pandemic, a notable increase in diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), conditions that warrant emergent management, was reported. We aimed to investigate the trend of DKA- and HHS-related mortality and excess deaths during the pandemic.
METHODS: Annual age-standardized mortality rates related to DKA and HHS between 2006 and 2021 were estimated using a nationwide database. Forecast analyses based on prepandemic data were conducted to predict the mortality rates during the pandemic. Excess mortality rates were calculated by comparing the observed versus predicted mortality rates. Subgroup analyses of demographic factors were performed.
RESULTS: There were 71 575 DKA-related deaths and 8618 HHS-related deaths documented during 2006-2021. DKA, which showed a steady increase before the pandemic, demonstrated a pronounced excess mortality during the pandemic (36.91% in 2020 and 46.58% in 2021) with an annual percentage change (APC) of 29.4% (95% CI: 16.0%-44.0%). Although HHS incurred a downward trend during 2006-2019, the excess deaths in 2020 (40.60%) and 2021 (56.64%) were profound. Pediatric decedents exhibited the highest excess mortality. More than half of the excess deaths due to DKA were coronavirus disease 2019 (COVID-19) related (51.3% in 2020 and 63.4% in 2021), whereas only less than a quarter of excess deaths due to HHS were COVID-19 related. A widened racial/ethnic disparity was observed, and females exhibited higher excess mortality than males.
CONCLUSIONS: The DKA- and HHS-related excess mortality during the pandemic and relevant disparities emphasize the urgent need for targeted strategies to mitigate the escalated risk in these populations during public health crises.
METHODS: Annual age-standardized mortality rates related to DKA and HHS between 2006 and 2021 were estimated using a nationwide database. Forecast analyses based on prepandemic data were conducted to predict the mortality rates during the pandemic. Excess mortality rates were calculated by comparing the observed versus predicted mortality rates. Subgroup analyses of demographic factors were performed.
RESULTS: There were 71 575 DKA-related deaths and 8618 HHS-related deaths documented during 2006-2021. DKA, which showed a steady increase before the pandemic, demonstrated a pronounced excess mortality during the pandemic (36.91% in 2020 and 46.58% in 2021) with an annual percentage change (APC) of 29.4% (95% CI: 16.0%-44.0%). Although HHS incurred a downward trend during 2006-2019, the excess deaths in 2020 (40.60%) and 2021 (56.64%) were profound. Pediatric decedents exhibited the highest excess mortality. More than half of the excess deaths due to DKA were coronavirus disease 2019 (COVID-19) related (51.3% in 2020 and 63.4% in 2021), whereas only less than a quarter of excess deaths due to HHS were COVID-19 related. A widened racial/ethnic disparity was observed, and females exhibited higher excess mortality than males.
CONCLUSIONS: The DKA- and HHS-related excess mortality during the pandemic and relevant disparities emphasize the urgent need for targeted strategies to mitigate the escalated risk in these populations during public health crises.
摘要：
背景：在大流行期间，糖尿病酮症酸中毒（DKA）和高渗性高血糖状态（HHS）显着增加，需要紧急管理的条件，已报告。我们旨在调查大流行期间DKA和HHS相关死亡率和超额死亡的趋势。
方法：使用全国数据库估算了2006年至2021年与DKA和HHS相关的年年龄标准化死亡率。进行了基于前流行数据的预测分析，以预测大流行期间的死亡率。通过比较观察到的死亡率与预测的死亡率来计算超额死亡率。进行人口统计学因素的亚组分析。
结果：在2006-2021年期间，记录了71575例DKA相关死亡和8618例HHS相关死亡。DKA,在大流行之前显示出稳定的增长，在大流行期间显示出明显的超额死亡率(2020年为36.91%，2021年为46.58%)，年百分比变化(APC)为29.4%(95%CI:16.0%-44.0%)。尽管HHS在2006-2019年期间呈下降趋势，但2020年（40.60％）和2021年（56.64％）的超额死亡人数却很严重。儿科死者表现出最高的超额死亡率。DKA导致的超额死亡人数中有一半以上与2019年冠状病毒病（COVID-19）相关（2020年为51.3%，2021年为63.4%），而HHS导致的超额死亡中只有不到四分之一与COVID-19相关。观察到种族/族裔差异扩大，女性的死亡率高于男性。
结论：大流行期间与DKA和HHS相关的超额死亡率和相关差异强调迫切需要有针对性的策略来减轻公共卫生危机期间这些人群的风险升级。
方法：使用全国数据库估算了2006年至2021年与DKA和HHS相关的年年龄标准化死亡率。进行了基于前流行数据的预测分析，以预测大流行期间的死亡率。通过比较观察到的死亡率与预测的死亡率来计算超额死亡率。进行人口统计学因素的亚组分析。
结果：在2006-2021年期间，记录了71575例DKA相关死亡和8618例HHS相关死亡。DKA,在大流行之前显示出稳定的增长，在大流行期间显示出明显的超额死亡率(2020年为36.91%，2021年为46.58%)，年百分比变化(APC)为29.4%(95%CI:16.0%-44.0%)。尽管HHS在2006-2019年期间呈下降趋势，但2020年（40.60％）和2021年（56.64％）的超额死亡人数却很严重。儿科死者表现出最高的超额死亡率。DKA导致的超额死亡人数中有一半以上与2019年冠状病毒病（COVID-19）相关（2020年为51.3%，2021年为63.4%），而HHS导致的超额死亡中只有不到四分之一与COVID-19相关。观察到种族/族裔差异扩大，女性的死亡率高于男性。
结论：大流行期间与DKA和HHS相关的超额死亡率和相关差异强调迫切需要有针对性的策略来减轻公共卫生危机期间这些人群的风险升级。
