ORIGINAL RESEARCH article
Front. Public Health
Sec. Health Economics
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1597297
Pandemic-Driven Healthcare Disruptions and Their Disproportionate Impact on Patients with Diabetes: Evidence from Texas
Provisionally accepted
- 1Department of Social Sciences, Economics Division, University of Texas at Tyler, Tyler, United States
- 2School of Health, Georgetown University, Washington, District of Columbia, United States
- 3University of Texas Southwestern Medical Center, Dallas, Texas, United States
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Background: Diabetic Ketoacidosis (DKA) is a life-threatening complication of uncontrolled diabetes. The COVID-19 pandemic may have increased DKA incidences and worsened outcomes both through the potential diabetogenic effects of SARS-CoV-2 infection (direct effect) and through pandemic-related disruptions in healthcare (indirect effects,) including delays in seeking or receiving care, reduced access to routine outpatient services, and strains on hospital capacity. The objective of this study is to examine changes in the frequency and outcomes of hospitalizations with DKA in Texas hospitals following the COVID-19 pandemic and to quantify the contributions of pandemic-related healthcare disruptions and SARS-CoV-2 infection. Comparisons to patients with Acute Myocardial Infarction (AMI) and Acute Kidney Injury (AKI) were made to assess the disproportionate impacts of healthcare system disruptions on DKA patients. Methods: This retrospective observational study uses regression analyses to evaluate the relative contributions of healthcare disruptions and viral infection on DKA frequency, in-hospital mortality, and length of stay. Event study and difference-in-differences models are employed to analyze whether DKA cases were disproportionately affected compared to patients with AMI or AKI. Quarterly inpatient discharge records from 2018 to 2021 are obtained from the Texas Department of State Health Services. Over 8 million discharge records are examined. Results: DKA hospitalizations increased by 8% post-pandemic, with half of the increase attributable to pandemic-induced healthcare disruptions (indirect effects.) The average mortality of patients with DKA increased by 44% compared to the pre-pandemic average. Non-COVID channels contributed to a 30% increase in mortality. Compared to AMI and AKI patients, DKA patients were disproportionately affected by pandemic-induced disruptions. Discussion: The COVID-19 pandemic significantly impacted DKA outcomes through the direct effects of SARS-CoV-2 infection and through various healthcare system disruptions—such as reduced access to routine diabetes care, delays in seeking treatment, and hospital resource
Keywords: COVID-19 pandemic, SARS-CoV-2 virus, healthcare disruptions, In-hospital mortality, Length of Stay, Diabetic ketoacidosis (DKA), diabetes
Received: 20 Mar 2025; Accepted: 15 Sep 2025.
Copyright: © 2025 SAYGILI, Gollu and Tekin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: MERYEM SAYGILI, tekinmrym@gmail.com
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