Advertisement

Social Determinants of Health on Glycemic Control in Pediatric Type 1 Diabetes

Published:January 28, 2013DOI:https://doi.org/10.1016/j.jpeds.2012.12.010

      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.
      DA(s) (Dissemination Area(s)), DI (Deprivation Index (Indices)), SDH (Social determinants of health), T1D (Type 1 diabetes), INSPQ-DI (Institut national de santé publique du Québec-DI), ON-Marg (Ontario Marginalization Index), SickKids (The Hospital for Sick Children)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Secrest A.M.
        • Costacou T.
        • Gutelius B.
        • Miller R.G.
        • Songer T.J.
        • Orchard T.J.
        Associations between socioeconomic status and major complications in type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complication (EDC) study.
        Ann Epidemiol. 2011; 21: 374-381
        • Carter P.J.
        • Cutfield W.S.
        • Hofman P.L.
        • Gunn A.J.
        • Wilson D.A.
        • Reed P.W.
        • et al.
        Ethnicity and social deprivation independently influence metabolic control in children with type 1 diabetes.
        Diabetologia. 2008; 51: 1835-1842
        • Stallwood L.
        Relationship between caregiver knowledge and socioeconomic factors on glycemic outcomes of young children with diabetes.
        J Spec Pediatr Nurs. 2006; 11: 158-165
        • Gallegos-Macias A.R.
        • Macias S.R.
        • Kaufman E.
        • Skipper B.
        • Kalishman N.
        Relationship between glycemic control, ethnicity and socioeconomic status in Hispanic and white non-Hispanic youths with type 1 diabetes mellitus.
        Pediatr Diabetes. 2003; 4: 19-23
        • Johns C.
        • Faulkner M.S.
        • Quinn L.
        Characteristics of adolescents with type 1 diabetes who exhibit adverse outcomes.
        Diabetes Educ. 2008; 34: 874-885
        • Cutfield S.W.
        • Derraik J.G.
        • Reed P.W.
        • Hofman P.L.
        • Jefferies C.
        • Cutfield W.S.
        Early markers of glycaemic control in children with type 1 diabetes mellitus.
        PLoS One. 2011; 6: e25251
        • Ismail I.S.
        • Nazaimoon W.M.
        • Mohamad W.B.
        • Letchuman R.
        • Singaraveloo M.
        • Pendek R.
        • et al.
        Sociodemographic determinants of glycaemic control in young diabetic patients in peninsular Malaysia.
        Diabetes Res Clin Pract. 2000; 47: 57-69
        • Araujo M.B.
        • Mazza C.S.
        Assessment of risk factors of poor metabolic control in type 1 diabetic children assisted in a public hospital in Argentina.
        Pediatr Diabetes. 2008; 9: 480-487
        • Auslander W.F.
        • Thompson S.
        • Dreitzer D.
        • White N.H.
        • Santiago J.V.
        Disparity in glycemic control and adherence between African-American and Caucasian youths with diabetes. Family and community contexts.
        Diabetes Care. 1997; 20: 1569-1575
        • Thompson S.J.
        • Auslander W.F.
        • White N.H.
        Comparison of single-mother and two-parent families on metabolic control of children with diabetes.
        Diabetes Care. 2001; 24: 234-238
      1. Factors influencing glycemic control in young people with type 1 diabetes in Scotland: a population-based study (DIABAUD2).
        Diabetes Care. 2001; 24: 239-244
        • Wang J.T.
        • Wiebe D.J.
        • White P.C.
        Developmental trajectories of metabolic control among White, Black, and Hispanic youth with type 1 diabetes.
        J Pediatr. 2011; 159: 571-576
        • Pampalon R.
        • Hamel D.
        • Gamache P.
        • Raymond G.
        A Deprivation Index for health planning in Canada.
        Chronic Dis Can. 2009; 29: 178-191
        • Pampalon R.
        • Hamel D.
        • Gamache P.
        A comparison of individual and area-based socio-economic data for monitoring social inequalities in health.
        Health Rep. 2009; 20: 85-94
        • Bajekal M.
        • Jan S.
        • Jarman B.
        The Swedish UPA score: an administrative tool for identification of underprivileged areas.
        Scand J Soc Med. 1996; 24: 177-184
        • Fukuda Y.
        • Nakamura K.
        • Takano T.
        Higher mortality in areas of lower socioeconomic position measured by a single index of deprivation in Japan.
        Public Health. 2007; 121: 163-173
        • Rey G.
        • Jougla E.
        • Fouillet A.
        • Hemon D.
        Ecological association between a Deprivation Index and mortality in France over the period 1997-2001: variations with spatial scale, degree of urbanicity, age, gender, and cause of death.
        BMC Public Health. 2009; 9: 33
      2. The INSPQ Deprivation Index for Health in Canada: Applications for Research, Policy and Practice. Canadian Institute for Health Information Workshop Proceedings Report. Montreal, Quebec, September 23, 2009. Available from: www.cihi.ca. Accessed January 22, 2013.

        • Pampalon R.
        • Gamache P.
        • Hamel D.
        The Quebec index of material and social deprivation: methodological follow-up, 1991 through 2006.
        Institut National de Sante Publique du Quebec, Government of Quebec;. 2011; (Available from:) (Accessed January 22, 2013)
        • Gamache P.
        • Pampalon R.
        • Hamel D.
        The material and social deprivation index: a summary.
        Institut National de Sante Publique du Quebec, Government of Quebec;. 2010; (Available from:) (Accessed January 22, 2013)
      3. Ontario Marginalization Index. McMaster University. Available from: http://www.crunch.mcmaster.ca/ontario-marginalization-index. Accessed January 22, 2013.

      4. Visible minority of person. Statistics Canada, 2012 (Available at:) (Accessed January 22, 2013)
      5. Postal Code Conversion File (PCCF). Statistics Canada, 2006 (Available at:)
        • Chen W.H.
        • Myles J.
        • Picot G.
        Why have poorer neighbourhoods stagnated economically, while the richer have flourished? Neighbourhood income inequality in canadian cities.
        CLSRN Working Papers, 2011
        • Baum-Snow N.
        • Pavan R.
        Inequality and City Size.
        Conditonally accepted at Review of Economics and Statistics. 2011; (Available at:) (Accessed January 22, 2013)
      6. Visual census: ethnic origin and visible minorities, Canada. Statistics Canada, 2010 (Available at:) (Accessed January 22, 2013)
        • Baumer J.H.
        • Hunt L.P.
        • Shield J.P.
        Social disadvantage, family composition, and diabetes mellitus: prevalence and outcome.
        Arch Dis Child. 1998; 79: 427-430
        • Senniappan S.
        • Hine P.
        • Tang W.
        • Campbell J.
        • Bone M.
        • Sankar V.
        • et al.
        The effect of socioeconomic deprivation on efficacy of continuous subcutaneous insulin infusion: a retrospective paediatric case-controlled survey.
        Eur J Pediatr. 2012; 171: 59-65
        • de Bock M.
        • Gunn A.J.
        • Holt J.A.
        • Derraik J.G.
        • Reed P.
        • Cutfield W.
        • et al.
        Impact of insulin pumps on glycaemic control in a pump-naive paediatric regional population.
        J Paediatr Child Health. 2012; 48: 247-252
      7. Insulin Pump and Supplies Policy and Administration Manual. Ministry of Health and Long-Term Care, Government of Ontario; September 2012. Available from: http://www.health.gov.on.ca/en/pro/programs/adp/publications.aspx. Accessed January 22, 2013.

      Linked Article