B54-02 The Relationship Between Social Deprivation and Severity of Diabetic Ketoacidosis at Presentation to the Intensive Care Unit

Abstract Rationale Diabetic ketoacidosis (DKA) is a potentially life-threatening diagnosis in the medical intensive care unit (ICU). Approximately three-quarters of patients with DKA require ICU admission. Factors such as young age, being Black, suboptimal glycemic control, lower socioeconomic status may lead to increased DKA admissions. Social inequalities instinctively influence access to healthcare and disease outcomes with diabetes. In this study, we hypothesized that people residing in more socially deprived areas were more likely to be admitted to the ICU with more severe DKA. Methods This single-center retrospective study reviewed patients with DKA admitted to the ICU at University Hospital at Downstate between June 2019 and May 2024. Patient’s home ZIP codes were matched with Social Deprivation Index (SDI) scores from the Robert Graham Center publicly available dataset, which assigns values from 0 to 100 based on income, education, housing, employment, family structure, and transportation access (higher scores indicating greater deprivation). DKA severity was classified into mild, moderate, and severe per American Diabetes Association criteria. The association between SDI and DKA severity on admission to the ICU was evaluated by Poisson regression model, adjusting for age, race, gender, comorbidities, and body mass index (BMI). Results were displayed in a forest plot. Results The final sample included 45 patients with mean SDI of 88.4 (σ = 8.34), suggesting overall high social deprivation. On admission, about 58% of patients had mild or moderate and 42% had severe DKA. The Poisson regression model had a low residual deviance (13.65 on 37 degrees of freedom) with a non-significant goodness-of-fit p-value (p = 0.9998), indicating no evidence of lack-of-fit compared with the saturated model. SDI was not found to be a significant predictor of DKA severity on admission (incidence rate ratio - IRR = 1.006, 95% CI: 0.98-1.03, p = 0.669). Comorbidity count, BMI, race, and age also did not yield significant effects (Figure 1). Conclusions To our knowledge, this is a unique study to specifically investigate associations of social deprivation indices with illness severity in adult DKA patients admitted to the ICU. In this study, the social deprivation index was not associated with greater DKA severity on ICU admission. The lack of association may reflect that factors beyond baseline social deprivation indices play a greater role in DKA severity on presentation to the ICU. While the model had good fit, future studies including more socioeconomically diverse populations may better clarify this relationship. This abstract is funded by: self-funded