Social determinants affected glycemic control in pediatric patients with type 1 diabetes
Canadian Pediatric Endocrine Group
Factors such as socioeconomic status, education and family structure influence glycemic control in pediatric patients with type 1 diabetes, data from a poster presented at the Canadian Pediatric Endocrine Group 2012 Scientific Meeting suggest.
Despite universal access to health care, investigators at the Hospital for Sick Children in Toronto found some segments of their patient population had better HbA1c control than others, according to Farid H. Mahmud, MD, FRCPC, a pediatric endocrinologist at the Hospital for Sick Children and an assistant professor at the University of Toronto.
“Social determinants of health impact our patients,” Mahmud told Endocrine Today, describing the patient population in his pediatric diabetes clinic as diverse.
Mahmud and pediatric endocrine research fellow Caroline Zuijdwijk, MD,FRCPC, de-identified patient postal code information and linked it to established indices of material and social deprivation, which are validated measures based on 2006 Canadian Census data. The material deprivation index is a marker of education and socioeconomic status, and the social deprivation index is a measure of family structure. They also looked at ethnic concentration from the Ontario Marginalization Index (ON-Marg). Each index is reported as a quintile score (1st quintile: least deprived, and 5th quintile: most deprived) for each dissemination area (smallest geographic area for which census data is disseminated) in Canada.
Mean patient HbA1c values were examined and related to quintile scores for three indices, including material deprivation index, social deprivation index and ethnic concentration.
They found that HbA1c values are associated with all three indices (1st vs. 5th quintile), including material deprivation (8.3% vs. 8.9%, P≤.0001), social deprivation (8.4% vs. 8.8%, P=.0156) and ethnic concentration (8% vs. 8.8%, P=.0003).
The quintile that was the least socioeconomically advantaged had the highest HbA1c level, whereas the most socioeconomically advantaged quintile had the lowest HbA1c level, Mahmud said, adding that the effect of income disparities is evident in his pediatric diabetes clinic.
“Our conclusion is that we need to do more,” Mahmud said. “We want to design ways to overcome inequities. Our next step is [developing] targeted interventions for those at highest risk.”
Gillian Booth, MD, FRCPC, an adult endocrinologist at St. Michael’s Hospital in Toronto, an associate professor in the department of medicine at the University of Toronto and an adjunct scientist at the Institute for Clinical Evaluative Sciences, said the findings are significant.
“The study shows there is a difference in glycemic control in children who live in materially deprived areas,” said Booth, who has published data on the relationship between socioeconomic status and acute complications of diabetes in Ontario. Her data demonstrated that those in the lowest income quintile were 44% more likely to experience a hospitalization or ED visit than those in the highest quintile.
Booth recommended interventions to target populations at higher risk for poor glycemic control.
For more information:
- Zuijdwijk C. Presented at: the Canadian Pediatric Endocrine Group 2012 Scientific Meeting; Feb. 9-11, 2012; Winnipeg, MB, Canada.
Disclosure: Drs. Mahmud and Booth report no relevant financial disclosures.
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