title: Geographic Clustering of Acute Complications and Sociodemographic Factors in Adults with Type 1 Diabetes.
abstract: OBJECTIVE
  To assess the geographic distribution of acute complications in patients with type 1 diabetes in a large urban centre; and to assess the association between acute complications and community-level sociodemographic factors.
  
  
  METHODS
  Adults (aged ≥18 years old) with type 1 diabetes and acute complications were identified between 2004 and 2008 by using a diabetes centre clinical database or discharge abstracts for acute complications (diabetic ketoacidosis or hypoglycemia). Using a geographic information system, hot-spot analysis was used to identify spatial clusters of acute complications in a large urban centre. The association between acute complications and community-level sociodemographic factors were assessed by Spearman rank correlation.
  
  
  RESULTS
  We identified 1779 patients with type 1 diabetes, of whom 456 had been hospitalized for acute complications. The mean age of patients was 40.9±16.0 years, and men were more likely to have acute complications (59.2% vs. 52.3%; p<0.01). Spatial clusters of high values and low values were identified. Higher median family income (r=-0.36; p<0.0001) and higher education levels (r=-0.30; p<0.0001) were associated with lower rates of acute complications.
  
  
  CONCLUSIONS
  This study demonstrated geographic clusters of hospitalizations for acute complications and important community sociodemographic factors. Prevention strategies and interventions targeting these geographic and sociodemographic disparities need to be explored as a means of minimizing hospitalizations for acute complications.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada. Electronic address: sbutalia@ucalgary.ca.
authors.forename: Sonia
authors.initials: S
authors.lastname: Butalia
authors.affiliation: O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Alka B
authors.initials: AB
authors.lastname: Patel
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Johnson
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Doreen M
authors.initials: DM
authors.lastname: Rabi
mesh_terms: D000328:Adult; D048909:Diabetes Complications / Q000453:epidemiology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology; D004522:Educational Status; D006760:Hospitalization; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D008875:Middle Aged; D012959:Socioeconomic Factors
keywords: acidocétose diabétique; acute complications; complications à court terme; diabetic ketoacidosis; diabète de type 1; facteurs sociodémographiques; geography; géographie; hypoglycemia; hypoglycémie; sociodemographic factors; type 1 diabetes