Social Determinants of Health on Glycemic Control in Pediatric Type 1 Diabetes
ABSTRACT OBJECTIVE: To evaluate the relationship between the social determinants of health (SDH) and glycemic control in a large pediatric type 1 diabetes (T1D) population. STUDY DESIGN: Deprivation Indices (DI) were used to ascertain population-level measures of socioeconomic status, family structure, and ethnicity in patients with T1D followed at The Hospital for Sick Children August 2010-2011 (n = 854). DI quintile scores were determined for individual patients based on de-identified postal codes, and linked to mean patient A1Cs as a measure of glycemic control. We compared mean A1C between the most and least deprived DI quintiles. Associations were estimated controlling for age and sex, and repeated for insulin pump use. RESULTS: The T1D population evaluated in this study was most concentrated in the least and most deprived quintiles of the Material DI. A1C levels were highest in patients with the greatest degree of deprivation (fifth vs first quintile) on the Material DI (9.2% vs 8.3%, P < .0001), Social DI (9.1% vs 8.3%, P < .0001), and Ethnic Concentration Index (8.9% vs 8.4%, P = .03). These relationships between measures of the SDH and A1C were not evident for patients on insulin pumps. On regression analysis, higher A1C was predicted by older age, female sex, not using pump therapy, and being in the most deprived quintile for Material and Social Deprivation, but not Ethnic Concentration. CONCLUSIONS: Measures of the SDH comprising Material and Social Deprivation were significantly associated with suboptimal glycemic control in our pediatric T1D cohort. Use of insulin pump therapy also predicted A1C and may have a moderating effect on these relationships.
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ABSTRACT: To investigate the relation between social disadvantage and family composition on diabetes prevalence and diabetes care outcome. Retrospective audit in the south west of England of 801 children with diabetes mellitus. Prevalence of diabetes in relation to the Townsend index. Admissions to hospital with diabetes related problems, glycated haemoglobin, time spent in hospital, outpatient attendance rates. There was no association between social status and diabetes prevalence. Social deprivation increased the likelihood of admission for hypoglycaemia. Children living with a single parent were more likely to be admitted to hospital with a diabetes related problem and stay in hospital longer. Having either a parent with diabetes or a single parent increased the rates of clinic non-attendance. No association was identified between medium term diabetes control and either social disadvantage or single parent status. Social disadvantage has no effect on diabetes prevalence and little on diabetes outcome in childhood. Family structure and parental diabetes have adverse effects on some aspects of diabetes outcome.Archives of Disease in Childhood 12/1998; 79(5):427-30. DOI:10.1136/adc.79.5.427 · 2.91 Impact Factor
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ABSTRACT: To determine if there is a disparity in glycemic control between Hispanic and white non-Hispanic children and adolescents with type 1 diabetes mellitus (DM) and to delineate the factors associated with glycemic control in these populations. This cross-sectional study included 183 youths with type 1 DM (99 white non-Hispanics and 84 Hispanics) and their parents/guardians cared for in a well-defined, private pediatric endocrine diabetes clinic, where the same physician and diabetes educators treat all patients. The youths were invited to participate if they had been diagnosed with diabetes at least 3 months before the study and were < 21 yr of age. Self-report questionnaires and chart reviews were used to assess individual familial and sociodemographic variables. Mean hemoglobin A1c (HbA1c) levels, compliance with home monitoring of blood sugar, level of parental supervision of treatment, and socioeconomic status of Hispanic and white non-Hispanic families in the study. Hispanic youths with type 1 DM were in poorer metabolic control than their white non-Hispanic counterparts (0.45% difference in HbA1c levels, p = 0.02). Hispanic youths exhibited lower compliance with home monitoring of blood sugar but their parents reported greater supervision of their diabetes treatment. Hispanic families were found to have significantly lower income, rate of health insurance, father's educational attainment, and mother's educational attainment. Lower family socioeconomic status, but not ethnicity or educational attainment of parents, was associated with a significantly higher HbA1c, regardless of ethnicity. This study suggests that Hispanic youths with type 1 diabetes may be at greater risk for poor glycemic control because of their lower socioeconomic status rather than their ethnicity.Pediatric Diabetes 03/2003; 4(1):19-23. DOI:10.1034/j.1399-5448.2003.00020.x · 2.13 Impact Factor
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ABSTRACT: To describe the relationship between caregiver diabetes knowledge and socioeconomic factors on glycemic outcomes of young children with type 1 diabetes. Seventy-three caregivers of children less than 9 years of age were conveniently sampled and completed the Michigan Diabetes Research and Training Center Diabetes Knowledge Test and a demographic questionnaire. Higher caregiver knowledge was associated with lower hemoglobin A1c (HbA1c) levels, higher income levels, and being married. Thirty-three (44%) children had HbA1c levels within the target range. Perform ongoing knowledge assessments and educational interventions related to deficits, with a special focus on families in lower socioeconomic situations.Journal for Specialists in Pediatric Nursing 08/2006; 11(3):158-65. DOI:10.1111/j.1744-6155.2006.00062.x · 1.05 Impact Factor