Socioeconomic determinants of recurrent DKA in US children

Recurrent diabetic ketoacidosis (DKA) imposes a significant clinical burden in children living with diabetes. Socioeconomic status is a well-established determinant of DKA, but the seminal systematic review showing this association dates to 2012. Given shifts in epidemiology and health equity, an up-to-date review is needed. A systematic search of PubMed, Scopus, Cochrane Library, and CINAHL was conducted for U.S. studies linking socioeconomic factors to recurrent DKA in pediatric populations. Data were extracted using a standardized form to capture study characteristics, socioeconomic exposures, and measures of recurrent DKA (e.g., readmission rates). Results were synthesized descriptively, and study quality was appraised using the Newcastle-Ottawa Scale. Sixteen observational studies were included, identifying multiple socioeconomic influences on DKA recurrence. Strong associations were found at the household level, where lower income and public insurance were linked to higher recurrence rates. At the neighborhood level, residence in areas of high disadvantage or low opportunity significantly increased the odds of recurrence. Patient-level factors (Black race, lower parental education) and systemic factors (homelessness, limited technology access) were also consistently associated with higher recurrence. This review demonstrates that socioeconomic factors significantly influence the risk of recurrent DKA in U.S. children.