2258-P: Housing Insecurity and Hyperglycemic Crises: A Nationwide Analysis of Clinical Profiles and Outcomes

Introduction and Objective: Housing insecurity disrupts access to medications, nutrition, and continuity of care, which are essential for diabetes management. We aimed to determine whether housing insecurity is associated with differences in clinical characteristics and hospital outcomes among adults hospitalized with hyperglycemic crises. Methods: We performed a retrospective analysis of adults aged ≥18 years hospitalized with diabetic ketoacidosis or hyperosmolar hyperglycemic state using the 2022 Nationwide Readmissions Database. Variables were identified using ICD-10-CM codes. Survey-weighted multivariable regression models adjusted for demographics, payer status, and major comorbidities were used to evaluate length of stay (LOS), hospital charges, discharge disposition, and 30 day readmission. Results: Among an estimated 237, 904 hospitalizations, housing insecurity was present in 3. 2%, those with housing insecurity were younger (42. 2 vs 45. 4 years), more often male (72% vs 53%), and more likely to have Medicaid (60% vs 34%). Despite lower rates of obesity (7% vs 16%), coronary artery disease (7% vs 11%), heart failure (4% vs 8%), and CKD (10% vs 17%), housing insecurity was associated with higher prevalence of malnutrition (12% vs 7%), substance use disorders (39% vs 12%), and psychiatric illness (42% vs 29%). After adjustment, housing insecurity was associated with longer LOS (4. 87 vs 3. 75 days), higher hospital charges (50, 30 vs 42, 42), higher odds of thirty-day readmission (adjusted odds ratio (aOR) 2. 32), greater likelihood of discharge to skilled nursing facilities (aOR 2. 41), and higher rates of discharge against medical advice (14% vs 6%). Conclusion: Adults with housing insecurity hospitalized for hyperglycemic crises experience worse inpatient and post-discharge outcomes despite a lower burden of cardiometabolic comorbidity. Addressing housing instability, behavioral health conditions, and discharge support may be important for reducing recurrent hyperglycemic crises and preventable readmissions. Disclosure T. Anagreh: None. L. Sorour: None. B. Varghese: None.