scholarly journals The surge in fatal diabetic ketoacidosis in the years of the COVID-19 pandemic: a forensic autopsy study

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S21-S22
Author(s):  
R L Geller ◽  
J Aungst ◽  
C Lee
Keyword(s):  
Diabetic Ketoacidosis ◽  
Cause Of Death ◽  
Undiagnosed Diabetes ◽  
Medical Examiner ◽  
Age At Death ◽  
Autopsy Study ◽  
Time Period ◽  
Previous Diagnosis ◽  
Undiagnosed Diabetes Mellitus

Abstract Introduction/Objective Although many deaths resulting from diabetic ketoacidosis (DKA) fall outside the legal jurisdiction of the medical examiner, a forensic pathologist may identify this cause of death through ancillary testing multiple times per year. We recognized a sharp increase in deaths due to DKA at a busy metropolitan medical examiner’s office in 2020 and 2021, coinciding with the COVID-19 pandemic. We hypothesize that in the majority of these cases, fatal DKA was the presenting symptom of previously undiagnosed diabetes mellitus (DM). Methods/Case Report We performed a retrospective autopsy review of all cases with a cause of death listed as “diabetic ketoacidosis” from January 1, 2018 through June 18, 2021. We compared the number of DKA deaths to all reported deaths from the same time period. Results (if a Case Study enter NA) We identified a total 34 cases of fatal DKA. In 2018, 5 cases of DKA were identified and all decedents had a known diagnosis of DM; the average age at death was 50.6 years (range: 40- 60 years) and 2 decedents were male (40%). In 2019, 5 cases of DKA were identified and 4 decedents had a known diagnosis of DM (80%); the average age at death was 51.4 years (range: 37- 61 years), and all decedents were male (100%). In 2021, 18 cases of DKA were identified and 9 decedents had a previous diagnosis of DM (50%); the average age at death was 43.5 years (range: 22- 64 years), 13 decedents were male (72%), and 1 decedent was COVID-19 positive (5.5%). In the first 6 months of 2021, 6 cases of DKA were identified and none of these decedents had a previous diagnosis of DM (0%); the average at death was 51.8 years (range: 35- 73 years), 4 decedents were male (66%), and 1 decedent was COVID-19 positive (16.6%). Reported deaths per year to our office are as follows: 2018 = 2585 deaths, 2019 = 2658 deaths, 2020 = 3091 deaths, and 2021 to date = 1482 deaths. Conclusion Coinciding with the COVID-19 pandemic, our office experienced a 16.2% increase in all reported deaths from 2019 to 2020, and a 260% increase in fatal DKA. In 2018 and 2019, 9 of the 10 decedents who died from DKA had a known diagnosis of DM (90%). However, in 2020 and the first half of 2021, DKA was the presenting symptom of previously undiagnosed DM in 15 of 24 cases of fatal DKA (62.5%). Further investigation must be done to examine the factors driving the recent surge in fatal DKA.

Sickle Cell Disease Mortality in the United States: Age at Death and Contributing Causes.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 81-81 ◽  
Author(s):  
Carlton Haywood ◽  
Sophie Lanzkron
Keyword(s):  
Sickle Cell Disease ◽  
Cause Of Death ◽  
Sickle Cell ◽  
Causes Of Death ◽  
College Education ◽  
Age At Death ◽  
Cell Disease ◽  
Time Period ◽  
Icd 10 ◽  
The U.S

Abstract BACKGROUND: In the early 1990’s, the Cooperative Study of Sickle Cell Disease (CSSCD) estimated a median life expectancy of 42 years for males, and 48 years for females with sickle cell anemia. We used death certificate data from the late 1990’s and early 2000’s to examine age at death and contributing causes of death for persons with sickle cell disease (SCD). METHODS: We used the National Center for Health Statistics Multiple Cause of Death (MCOD) files to examine age at death and contributing causes of death for persons in the U.S. with SCD during the years 1999 to 2004. The MCOD files contain data from all death certificates filed in the U.S. Each observation in the data has listed an underlying (primary) cause of death, as well as up to 20 conditions thought to contribute to the death. We used ICD-10 codes D570-D578 to identify all deaths attributed to SCD during the time period under study. Records with the ICD-10 code for sickle cell trait (D573) were excluded from further analyses. We used the Clinical Classification Software provided by the Healthcare Cost and Utilization Project to collapse all listed ICD-10 codes into smaller categories. Analyses of age at death were conducted using t-tests, median tests, ANOVA, and multiple linear regression as appropriate. RESULTS: From 1999 to 2004, there were 4553 deaths in the U.S. attributed to SCD (mean = 759/yr, sd = 42.6). SCD was listed as the primary cause in 65% of the deaths. 95% of the deaths were attributed to HbSS disease, and approximately 1% of the deaths were attributed to double heterozygous sickle cell disorders (SC/SD/SE/Thal). 50.4% of the deaths were among males. 64% of the decedents had a high school education or less. 54% of the decedents lived in the South. 68% of the decedents died as inpatients in a hospital. The mean age at death for the time period was 38.2 years (sd = 15.6). There was no change in the mean age at death during the time period. Females were older than males at death (39.4 vs. 36.9, p < 0.0001). Those with HbSS were younger than those with a double heterozygous disorder (38 vs. 47, p < 0.02). Having SCD listed as the primary cause of death was associated with younger age at death (36.8 vs. 40.7, p < 0.0001). Decedents with at least some college education were older at death than those with high school educations or less (40.9 vs. 37.0 p < 0.0001). There were no regional differences in mean age at death. In a multivariate model of age at death with the predictors gender, region, education, and whether or not SCD was listed as the primary cause of death, being female and having some college education remained associated with older age at death, while having SCD listed as the primary cause of death remained associated with younger age at death. Septicemia, pulmonary heart disease, liver disease and renal failure were among the top contributing causes of death for adults, while septicemia, acute cerebrovascular disease and pneumonia were among the top contributing causes of death for kids. CONCLUSIONS: Persons dying from SCD during 1999 to 2004 experienced ages at death that are not improved over those reported by the CSSCD, suggesting the continued need for societal efforts aimed at improving the quality of care for SCD, especially among adults with the condition. Educational attainment is associated with age at death among the SCD population, though it is not possible from the cross-sectional nature of this data to determine the causal directionality of this association.

Trends In Mortality Rates and Age of Death In Sickle Cell Disease (SCD): 1979–2005

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 736-736
Author(s):  
Sophie Lanzkron ◽  
Carlton Haywood
Keyword(s):  
Sickle Cell Disease ◽  
Mortality Rate ◽  
Cause Of Death ◽  
Sickle Cell ◽  
Mortality Rates ◽  
Age At Death ◽  
Cell Disease ◽  
Time Period ◽  
The Mean ◽  
Age Of Death

Abstract Abstract 736 While improvements in care have resulted in significant decreases in mortality for children with SCD, it is unclear if similar decreases in mortality rates have occurred in adults with the disease. The purpose of this research is to describe mortality rates and trends in age of death for those with SCD over the last 3 decades. We used the National Center for Health Statistics Multiple Cause of Death (MCOD) files to examine age at death and calculate mortality rates from 1979–2005. ICD9 and ICD10 codes for SCD were used as appropriate to identify sickle cell related deaths. Mortality rates were calculated as deaths per 100,000 African American population. The number of African Americans each year was determined using available census data. Trends in mortality rates were examined using negative binomial regression and age of death was examined using t-tests and linear regression. After excluding certificates with codes for sickle trait and those with multiple sickle codes we identified 16,654 sickle-related deaths. The age range was 0 to 107 years. Mean age of death was significantly different for men (33.4, 95% CI [33.0, 33.7]) and women (36.9, 95% CI [36.5, 37.4]). SCD was the most common listed underlying cause of death (COD) at 62.8%. Infection was the second most common COD (5.9%). Controlling for sex and the presence of infection as COD, the mean age of death increased significantly by 0.08 years (p<0.001) each year over the time period studied, with men on average dying 4.3 years earlier than women (p<0.001). The mean age of death in 2005 was 43 yrs for women and 37 yrs for men. Those with COD of pulmonary hypertension, stroke and renal disease had a significantly older age of death than those without those diagnoses, while having infection as the underlying COD was associated with a younger age at death. The overall mortality rate increased by 0.7% (p<0.001) each year over the time period studied. Mortality rates for adults and children over time are shown in Figure 1. The adult (>19 yrs) mortality rate increased by 1% (p<0.001) each year over the time period studied. The pediatric mortality rate decreased by 3% (p<0.001) each year over the time period studied. When controlling for the pediatric mortality rate the adult mortality rate increased by 1.6% (p<0.001) each year. This data confirms prior studies showing a significant decrease in mortality for children with sickle cell disease over the last 30 yrs. The mortality rate for the adult population appears to be steadily increasing over the same time period. It seems unlikely that this is due merely to an influx of younger patients surviving to adulthood. Further investigation as to the cause of the increasing mortality rate in adults is needed. Disclosures: No relevant conflicts of interest to declare.

Case Study of Emphysematous Osteomyelitis of Both Femoral Heads

2020 ◽  
Vol 22 (4) ◽  
pp. 273-282
Author(s):  
Andrii Sribniak ◽  
Vadym Sulyma ◽  
Roman Bihun ◽  
Zinovii Sribniak
Keyword(s):  
Diabetes Mellitus ◽  
Undiagnosed Diabetes ◽  
Trace Back ◽  
Femoral Heads ◽  
Undiagnosed Diabetes Mellitus

Early references of emphysematous osteomyelitis (EO) in the literature trace back to 1981, when the presence of intraosseous gas was mentioned in a paper of Ram et al.. Subsequently, 48 cases of EO were described. A significant underlying comorbidity was reported in most EO cases, especially diabetes and malignancy. This report presents a 37-year-old male with undiagnosed diabetes mellitus which was accompanied by emphysematous osteomyelitis of both femoral heads.

Medical Examiner Cases Associated With Previously Undiagnosed Diabetes Mellitus, North Carolina, 1994

1998 ◽  
Vol 91 (2) ◽  
pp. 151-154 ◽  
Author(s):  
RONNY A. BELL ◽  
DAWN HOWARD ◽  
MARILYN NORMAN ◽  
JOHN BUTTS ◽  
EUGENE J. LENGERICH
Keyword(s):  
Diabetes Mellitus ◽  
North Carolina ◽  
Undiagnosed Diabetes ◽  
Medical Examiner ◽  
Undiagnosed Diabetes Mellitus

Child and Adolescent Suicide Deaths in New Mexico, 1990-1994

Crisis ◽  
2000 ◽  
Vol 21 (1) ◽  
pp. 36-44 ◽  
Author(s):  
DD Werenko ◽  
LM Olson ◽  
L Fullerton-Gleason ◽  
AW Lynch ◽  
RE Zumwalt ◽  
...  
Keyword(s):  
New Mexico ◽  
Cause Of Death ◽  
American Indians ◽  
Adolescent Suicide ◽  
Suicide Attempts ◽  
Medical Examiner ◽  
Contributing Factors ◽  
Targeted Interventions ◽  
And Gender ◽  
Youth Activity

The suicide death rate in New Mexico is consistently higher than the national rate. Among adolescents, suicide is the third leading cause of death nationally, but in New Mexico it is the second leading cause of death. This study describes the pattern of adolescent suicide deaths in New Mexico. We conducted a retrospective review of all medical examiner autopsies for adolescent suicides (ages 20 years and younger) in New Mexico from 1990-1994. Records were reviewed for demographics and possible contributing factors such as depression, previous attempts, and alcohol and drug use. We identified 184 suicide deaths among children and adolescents ages 9-20 years for an overall rate of 12.9 per 100,000. Our rates for ages 5-9 years (0.2), 10-14 years (3.8), and 15-19 years (22.3) are over twice the U.S. rates. Suicide deaths resulted primarily from firearms (67%), hanging (16%), poisoning (6%), inhalation (4%), and other methods (7%). Method varied by ethnicity (p = .01) and gender (p = .03); males and non-Hispanic Whites were overrepresented among firearm deaths. Firearm ownership was known in 60 (48%) of the firearm deaths. Of these, 53% of the firearms belonged to a family member, 25% to the decedent, and 22% to a friend. Over one-third of decedents (41%) experienced mental disorders, primarily depressed mood and clinical depression. Previous suicide attempts were noted for 15% of the decedents. Some 50% of the decedents had alcohol or drugs present at the time of death; among American Indians/Alaska Natives, 74% had drugs or alcohol present (p = .003). Targeted interventions are needed to reduce adolescent suicide in New Mexico. We suggest raising awareness about acute and chronic contributing factors to suicide; training physicians to look for behavioral manifestations of depression; and involving physicians, teachers, and youth activity leaders in efforts to limit firearm accessibility, such as advising parents to remove firearms from their households.

1486-P: Identification of Undiagnosed Diabetes Mellitus and Associated Alternation of Predicted ASCVD Risk Using Chinese and U.S. Risk Calculators

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1486-P
Author(s):  
JING YANG ◽  
YANGLU ZHAO ◽  
YI REN ◽  
LIZHEN LAN ◽  
LINXIN XU ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Undiagnosed Diabetes ◽  
Ascvd Risk ◽  
Undiagnosed Diabetes Mellitus
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