title: Economic impact of diabetic ketoacidosis in a multiethnic indigent population: analysis of costs based on the precipitating cause.
abstract: OBJECTIVE
  Diabetic ketoacidosis (DKA) is a common complication of diabetes. We analyzed the inpatient costs of treating DKA in a multiethnic, indigent population in Houston, Texas.
  
  
  METHODS
  We measured the cost of resources utilized for all patients admitted to our hospital with DKA from 1 January to 31 December 1998. We also analyzed their medical records to determine the factors that precipitated the episode of DKA and then grouped them into three categories: acute illnesses, noncompliance with diabetes treatment, and new-onset diabetes. The data were analyzed by one-way ANOVA. The Tukey-Kramer procedure was used for post hoc multiple comparisons.
  
  
  RESULTS
  There were 167 admissions for DKA. The mean age was 40 +/- 13 years. The ethnic distribution was 49% African American, 32% Hispanic American, and 18% white. The total inhospital cost of treating DKA was $1,816,255. The mean cost per hospitalization was $10, 876 +/- 11,024. The frequency distribution by category of DKA-precipitating factor was 18% acute illness, 59% noncompliance, and 23% new onset. There were differences in mean cost of DKA associated with the three categories: $20,864 +/- 17,910 for acute illness, $11,863 +/- 8,701 for new onset, and $7,470 +/- 6,300 for noncompliance (P < 0.0001). The total cost for each category was $671,375 for acute illness, $694,082 for noncompliance, and $450,798 for new onset.
  
  
  CONCLUSIONS
  DKA is an expensive complication among indigent, multiethnic diabetic patients. Although the mean cost per admission was lowest for DKA precipitated by noncompliance, this causal category was responsible in sum for the greatest portion of the economic burden.
authors.affiliation: Division of Endocrinology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA. mariom@bcm.tmc.edu
authors.forename: Mario R
authors.initials: MR
authors.lastname: Maldonado
authors.forename: Erica R
authors.initials: ER
authors.lastname: Chong
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Oehl
authors.forename: Ashok
authors.initials: A
authors.lastname: Balasubramanyam
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D018864:Cultural Diversity; D016883:Diabetic Ketoacidosis / Q000191:economics* / Q000209:etiology; D005006:Ethnicity; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008499:Medical Records; D018579:Patient Selection; D013781:Texas