title: Evidence for a persistent, major excess in all cause admissions to hospital in children with type-1 diabetes: results from a large Welsh national matched community cohort study.
abstract: OBJECTIVE
  To estimate the excess in admissions associated with type1 diabetes in childhood.
  
  
  METHODS
  Matched-cohort study using anonymously linked hospital admission data.
  
  
  METHODS
  Brecon Group Register of new cases of childhood diabetes in Wales linked to hospital admissions data within the Secure Anonymised Information Linkage Databank.
  
  
  METHODS
  1577 Welsh children (aged between 0 and 15 years) from the Brecon Group Register with newly-diagnosed type-1 diabetes between 1999-2009 and 7800 population controls matched on age, sex, county, and deprivation, randomly selected from the local population.
  
  
  METHODS
  Difference in all-cause hospital admission rates, 30-days post-diagnosis until 31 May 2012, between participants and controls.
  
  
  RESULTS
  Children with type-1 diabetes were followed up for a total of 12,102 person years and were at 480% (incidence rate ratios, IRR 5.789, (95% CI 5.34 to 6.723), p<0.0001) increased risk of hospital admission in comparison to matched controls. The highest absolute excess of admission was in the age group of 0-5 years, with a 15.4% (IRR 0.846, (95% CI 0.744 to 0.965), p=0.0061) reduction in hospital admissions for every 5-year increase in age at diagnosis. A trend of increasing admission rates in lower socioeconomic status groups was also observed, but there was no evidence of a differential rate of admissions between men and women when adjusted for background risk. Those receiving outpatient care at large centres had a 16.1% (IRR 0.839, (95% CI 0.709 to 0.990), p=0.0189) reduction in hospital admissions compared with those treated at small centres.
  
  
  CONCLUSIONS
  There is a large excess of hospital admissions in paediatric patients with type-1 diabetes. Rates are highest in the youngest children with low socioeconomic status. Factors influencing higher admission rates in smaller centres (eg, "out of hours resources") need to be explored with the aim of targeting modifiable influences on admission rates.
authors: School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK.
authors: Adrian
authors: A
authors: Sayers
authors: Centre for Health Information Research and Evaluation, College of Medicine, Swansea University, Swansea, UK.
authors: Daniel
authors: D
authors: Thayer
authors: Wrexham Academic Unit, Bangor University, Wrexham, Bangor, UK.
authors: John N
authors: JN
authors: Harvey
authors: Diabetes Research Group, College of Medicine, Swansea University, Swansea, UK.
authors: Stephen
authors: S
authors: Luzio
authors: Centre for Health Information Research and Evaluation, College of Medicine, Swansea University, Swansea, UK.
authors: Mark D
authors: MD
authors: Atkinson
authors: Centre for Multi-level Modelling, University of Bristol, Bristol, UK.
authors: Robert
authors: R
authors: French
authors: Department of Child Health, University Hospital of Wales, Cardiff, UK.
authors: Justin T
authors: JT
authors: Warner
authors: Diabetes Research Group, Institute of Molecular & Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK.
authors: Colin M
authors: CM
authors: Dayan
authors: Diabetes Research Group, Institute of Molecular & Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK.
authors: Susan F
authors: SF
authors: Wong
authors: Diabetes Research Group, Institute of Molecular & Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK.
authors: John W
authors: JW
authors: Gregory
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014852:Wales / Q000453:epidemiology
keywords: DIABETES & ENDOCRINOLOGY; PAEDIATRICS