Objective: Racial disparities in pre-existing diabetes (PDM) and gestational diabetes (GDM) remain largely unexplored. We examine national PDM and GDM prevalence trends by race/ethnicity, and the association between these conditions and fetal death. Design: Retrospective cross-sectional analysis Setting: United States Nationwide Inpatient Sample Survey Population/Sample: A total of 69,539,875 pregnancy-related hospitalization from 2002 to 2017 including 674,040 women with PDM (1.0%) and 2,960,797 (4.3%) with GDM. Methods: Joinpoint regression was used to evaluate trends in prevalence. Survey logistic regression was used to evaluate the association between exposures (PDM and GDM) and outcome. Main Outcome Measures: National trends in PDM and GDM prevalence by race/ethnicity, and the association between these conditions and fetal death Results: Overall, the average annual increase in prevalence was 5.2% (95% CI [4.2, 6.2]) for GDM and 1.0% (95% CI [-0.1, 2.0]) for PDM, over the study period. Hispanic (AAPC 5.3; 95% CI [3.6, 7.1]) and NH-Black (AAPC 0.9; 95% CI [0.1, 1.7]) women had the highest average annual percent increase in prevalence of GDM and PDM, respectively. After adjustment, odds of stillbirth were highest for Hispanic (OR 2.41:95% CI [2.23, 2.60]) women with PDM and decreased for women with GDM (OR 0.51;95% CI [0.50, 0.53), irrespective of race/ethnicity. Conclusions and Global Health Implications: PDM and GDM prevalence is increasing in the U.S. with highest average annual percent changes seen among minority women. Further, reasons for variation in occurrence of stillbirths among mothers with PDM and GDM by race/ethnicity are not clear and warrant additional research.

Background: Sickle cell disease (SCD) is a genetic blood disorder that results in vaso-occlusive events and shortened lifespan. Medical advancements have led to a decrease in childhood mortality in SCD, but the transition period is associated with poor outcomes. We analyzed recent US hospitalizations and mortality trends in the transition-aged population and evaluated for differences between patients with and without SCD. Methods: Nationwide Impatient Sample (NIS) database was utilized to analyze hospitalizations among individuals aged 16-24 years from 2003-2017. Diagnoses were coded using ICD-9-CM and ICD-10-CM. Statistical analyses included: bivariate analyses to assess the association between socio-demographic characteristics, joinpoint regression analysis to describe trends in mortality rates, average annual percent change (AAPC) measures were calculated, and adjusted survey logistic regression to assess the association between patient characteristics and in-hospital mortality. Results: Our data captured 37,344,532 total patients between the age of 16 and 24 who were hospitalized during 2003-2017. Patients with SCD comprised of 1.20% of population with a significant +3.2% AAPC in hospitalizations. When comparing SCD to non-SCD hospitalization trends, we observed differences in gender, against-medical-advice discharge status, zip code income, and payer. SCD in-hospital mortality rates showed a non-significant -0.7% AAPC. However, in contrast to non-SCD patients, the odds ratios for in-hospital mortality significantly increased with age for SCD patients. Conclusion: During the transition period, SCD patients have an extremely increased likelihood of mortality. Proposed interventions to address this disparity must include targeting social determinants of health.