Background: Children and young people with type-1 diabetes (T1D) have excess all-cause hospital admissions, particularly younger children with lower socioeconomic status. Education on managing alcohol is provided to teenagers with T1D in paediatric clinics, but its effectiveness is unknown. We compared the risk of alcohol-related hospital admissions (ARHA) in young people with childhood-onset T1D with the general population for the same birth years.
Methods: We extracted data for 1 791 577 individuals born 19792014 with a GP registration in Wales, and record-linked these to ARHA between 1998 and June 2016 within the Secure Anonymised Information Linkage Databank (SAIL). Diabetes status was ascertained by record-linkage to a national register (Brecon Cohort), containing 3 575 children diagnosed with T1D aged <15 years since 1995. Linkage to the Welsh Demographic Service dataset provided information on age, sex and the lower super output areas (LSOAs) of residence, including moves, and linked Welsh Index of Multiple Deprivation 2008 quintiles. We censored for death or leaving Wales. We estimated hazard ratios (HRs) with 95% confidence intervals (95% CIs) for the risk of ARHA for sex, age and deprivation group using recurrent-event models, including interaction terms.
Results: There were 37 905 admissions and 19.1 million person-years of follow up. Individuals with T1D had 248 admissions (up to 4 admissions each), and overall had a 78% higher risk of ARHA (HR 1.78; 95% CI 1.601.98) adjusted for age group, sex and deprivation. In diabetic individuals the risk of ARHA was highest in the 1417 year-old age-group (HR 6.01; 95% CI 4.707.75), 2.7 times higher than the peak in the general population aged 1822 (HR 2.23, 95% CI 2.142.32), both relative to 11- to 13-year olds in the general population. Socioeconomic inequalities in ARHA were smaller for the T1D group.
Conclusions: Young people with T1D have increased risks of ARHA, highest at school age (1417 years) and earlier than the peak at student age (1822 years) in the general population. New effective interventions aiming to reduce alcohol-related harm in T1D are needed. These may include modification of current education and guidance for teenagers on managing alcohol consumption and reconsideration of criteria for hospital admission.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes