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Background: As children with diabetes transition to adulthood, they may be especially vulnerable to diabetic ketoacidosis (DKA). Cross-national comparisons may inform efforts to avoid this complication.Objective: To compare DKA hospitalization rates in the USA and Manitoba, Canada, during the vulnerable years known as "emerging adulthood."Design: Cross-sectional study using inpatient administrative databases in the USA (years 1998-2014) and Manitoba, Canada (years 2003-2013).Participants: Individuals aged 12-30 years hospitalized with DKA, identified using ICD-9 (USA) or ICD-10 codes (Manitoba).Main Measures: DKA hospitalization rates per 10,000 population by age (with a focus on those aged 15-17 vs. 19-21). Admissions were characterized by gender, socioeconomic status, year of hospitalization, and mortality during hospitalization.Key Results: The DKA rate was slightly higher in the USA among those aged 15-17: 4.8 hospitalizations/10,000 population vs. 3.7/10,000 in Manitoba. Among those aged 19-21, the DKA hospitalization rate rose 90% in the USA to 9.2/10,000, vs. 23% in Manitoba, to 4.5/10,000. In both the USA and Manitoba, rates were higher among those from poorer areas, and among adolescent girls compared with adolescent boys. DKA admissions rose gradually during the period under study in the USA, but not in Manitoba.Conclusions: In years of "emerging adulthood," the Canadian healthcare system appears to perform better than that of the USA in preventing hospitalizations for DKA. Although many factors likely contribute to this difference, universal and seamless coverage over the lifespan in Canada may contribute. [ABSTRACT FROM AUTHOR]

Background: As children with diabetes transition to adulthood, they may be especially vulnerable to diabetic ketoacidosis (DKA). Cross-national comparisons may inform efforts to avoid this complication., Objective: To compare DKA hospitalization rates in the USA and Manitoba, Canada, during the vulnerable years known as "emerging adulthood.", Design: Cross-sectional study using inpatient administrative databases in the USA (years 1998-2014) and Manitoba, Canada (years 2003-2013)., Participants: Individuals aged 12-30 years hospitalized with DKA, identified using ICD-9 (USA) or ICD-10 codes (Manitoba)., Main Measures: DKA hospitalization rates per 10,000 population by age (with a focus on those aged 15-17 vs. 19-21). Admissions were characterized by gender, socioeconomic status, year of hospitalization, and mortality during hospitalization., Key Results: The DKA rate was slightly higher in the USA among those aged 15-17: 4.8 hospitalizations/10,000 population vs. 3.7/10,000 in Manitoba. Among those aged 19-21, the DKA hospitalization rate rose 90% in the USA to 9.2/10,000, vs. 23% in Manitoba, to 4.5/10,000. In both the USA and Manitoba, rates were higher among those from poorer areas, and among adolescent girls compared with adolescent boys. DKA admissions rose gradually during the period under study in the USA, but not in Manitoba., Conclusions: In years of "emerging adulthood," the Canadian healthcare system appears to perform better than that of the USA in preventing hospitalizations for DKA. Although many factors likely contribute to this difference, universal and seamless coverage over the lifespan in Canada may contribute.

Objective: Traditional burden-of-disease estimates often exclude personality disorders, which are associated with significant mortality and morbidity. The aim of this study was to estimate the health-related quality of life (HRQoL) and annual population-level quality-adjusted life-year (QALY) losses associated with different mental and physical health conditions. In particular, it sought to quantify the impact of personality disorders on quality of life, at an individual and population level., Method: This was a secondary analysis of data from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey of the US general population collected from 2001 to 2005 (N = 34,653). Health-related quality of life (measured using the Short-Form Health Survey-6D) was the main outcome of interest. Regression analysis assessed the impact of various mental (based on DSM-IV criteria) and physical health conditions on HRQoL scores, and this impact was combined with the prevalence of disorders to estimate the population-level burden of disease., Results: Mood disorders were associated with the highest decrease in HRQoL scores, followed by strokes, psychotic illness, and arthritis (P < .01). The greatest annual population QALY losses were caused by arthritis, mood disorders, and personality disorders., Conclusions: Quality-adjusted life year losses associated with personality disorders ranked behind only mood disorders and arthritis. Personality disorders were associated with significant reductions in quality of life, despite the fact that they are often excluded from traditional burden of disease estimates., (© Copyright 2015 Physicians Postgraduate Press, Inc.)