Social Determinants of Health on Glycemic Control in Pediatric Type 1 Diabetes - 25/03/13
, Meaghan Cuerden, MSc 2, Farid H. Mahmud, MD 1
Reprint requests: Caroline S. Zuijdwijk, MD, Division of Endocrinology and Metabolism, The Children’s Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON K1H 8L1, Canada.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.
Le texte complet de cet article est disponible en PDF.Keyword : DA(s), DI, SDH, T1D, INSPQ-DI, ON-Marg, SickKids
Plan
| The authors declare no conflicts of interest. |
Vol 162 - N° 4
P. 730-735 - avril 2013 Retour au numéro
Article précédent
- Acute Kidney Injury in Asphyxiated Newborns Treated with Therapeutic Hypothermia
- David T. Selewski, Brian K. Jordan, David J. Askenazi, Ronald E. Dechert, Subrata Sarkar
- Body Mass Index at the Time of Diagnosis of Autoimmune Type 1 Diabetes in Children
- Brett M. Kaminski, Georgeanna J. Klingensmith, Roy W. Beck, William V. Tamborlane, Joyce Lee, Krishna Hassan, Desmond Schatz, Craig Kollman, Maria J. Redondo, Pediatric Diabetes Consortium ∗
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?