Persistent social disparities in the risk of hospital admission of paediatric diabetic patients in Germany-prospective data from 1277 diabetic children and adolescents.

BACKGROUND: Reduction of social inequality in health care is a major target in many countries. The risk of hospital admission is thought to be higher in diabetic children from socially deprived families but actual data are lacking.
METHODS: Based on a nationwide prospective computer-based documentation program (DPV), we determined the association between three social parameters (parental professional education, one-parent family vs. complete family, migration background) and the risk for post-onset hospital admission, as well as the number of hospital admission days in children and adolescents < 20 years of age with diabetes onset in 2002-2005 [n = 1277, 56% male, mean age at onset 8.5 (4.1) years]. We estimated relative risks with 95% confidence intervals, adjusting for age, sex, and diabetes centre (cluster), using random effect models.
RESULTS: Forty-two per cent of the study subjects were admitted to hospital at least once during follow-up. The incidence of hospital admissions was 0.46 (0.43-0.49) per person year, and there were 2.72 (2.65-2.80) hospital days per person year. Hospital admissions and hospital days were higher in girls than in boys (significant for hospital days, P < 0.05), and significantly lower in adolescents aged 15-19 compared with children aged 0-4 years (P < 0.05 in all models). Hospital admission rates were significantly higher in children from lower-educated parents, single-parent families, and families with a migration background (all P < 0.05). DISCUSSION: We found post-onset hospital admission rates to be higher in diabetic children and adolescents from socially deprived families. In comparison with an analysis in the 1990s, no decrease in social disparity in hospital admission risk was found.