Patients with type 1 diabetes are more likely to develop end-stage renal disease if their parents completed 12 or fewer years of education or received income support, according to findings from a longitudinal, register-based study in Sweden.
“In Sweden, the social welfare system is well developed,” Cecilia Toppe, of the department of internal medicine at Ryhov County Hospital in Jönköping, Sweden, and colleagues wrote. “All people with diabetes have access to free insulin and injection devices, and medical consultations are free of charge for children up to age of 18 years. Still, we find differences in the risk of complications due to parental education and social vulnerability in the parents. It is, therefore, important to develop strategies to find and help especially vulnerable patients as early as possible to limit the risk of complications and suffering, and to diminish health care costs and achieve a healthier, working population.”
Toppe and colleagues analyzed data from 9,287 patients with type 1 diabetes for at least 14 years from the Swedish Childhood Diabetes Registry. Data were also linked to the Labor Market Research Database maintained by Statistics Sweden, which includes education information, income and source of income and unemployment benefits on an individual and household level. Researchers used Cox regression analysis, with onset of diabetes to development of ESRD or end of study as the time variable, adjusting for age at onset and sex.
Within the cohort, 166 patients (1.8%) received renal replacement therapy; 154 developed ESRD due to diabetes. Those who developed ESRD were diagnosed with diabetes later (mean age, 10.6 years) vs. those who did not develop ESRD (mean age, 8.6 years).
In crude analysis, low maternal education was associated with a nearly threefold higher risk for children developing ESRD (HR = 2.9; 95% CI, 1.7-4.8); paternal education had a smaller effect (HR = 2.2; 95% CI, 1.3-3.6). Low patient education yielded the highest risk for ESRD development (HR = 5.7; 95% CI, 3.4-9.5)
Patients were also more likely to develop ESRD if either parent received income support (HR = 2.6; 95% CI, 1.9-3.6). The patient’s own need for income support was also linked to ESRD, but that association could be an effect rather than a cause of kidney disease, according to the researchers.
In combined effect models, researchers observed that age at onset of diabetes and the patient’s own education level held the strongest association with ESRD risk.
“Our study shows that socioeconomic factors clearly influence the development of ESRD in people with type 1 diabetes, and that the [socioeconomic status] of the parents is important,” the researchers wrote. “This emphasizes the need to acknowledge these aspects in diabetes care and to give special attention to socially deprived people, both during childhood and in adult care.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.