Access to this article is restricted until 12 months after publication by request of the publisher.. Restriction lift date: 2022-03-02
Social determinants of health, goals and outcomes in high-risk children with type 1 diabetes
Loading...
Files
Accepted Version
Date
2021-03-02
Authors
Hershey, J. A.
Morone, J.
Lipman, T. H.
Hawkes, Colin P.
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier B.V.
Published Version
Abstract
Introduction: Despite advances in technology and type 1 diabetes (T1D) care, children from low-income families continue to have suboptimal outcomes and increased healthcare utilization. This study aimed to describe social determinants of health (SDOH) in high-risk children with T1D, as well as their SDOH-related priority goals and to determine the correlation between SDOH, glycemic control, and healthcare utilization. Methods: Caregivers of children aged 4 to 18 years with a diagnosis of T1D >1 year, poor glycemic control (hemoglobin A1c (A1C) ≥ 9.5%) or high healthcare utilization (≥2 diabetes-related hospitalizations, emergency department attendances, or missed outpatient appointments in the prior year) were included. Primary caregiver health-related quality of life (HRQOL), self-efficacy (MSED), and SDOH were assessed. Goals were identified following assessment by a community health worker. Results: Fifty-three families were included; and most (n=48, 91%) had government insurance. Children had a median (IQR) age of 13.4 (12, 15.3) and median (IQR) A1C of 11.1 (10, 13) %. Almost half of the families (n=24, 45%) reported ≥1 adverse SDOH. One or more adverse SDOH was associated with significantly lower total HRQOL scores (56.6 [38.5, 70.7] vs. 77.8 [60.8, 92.4], p=0.004), but not associated with A1C (p=0.3), ED visits (p=0.9), or MSED (p=0.5). Discussion: Screening for adverse SDOH and addressing these barriers to glycemic control is not part of routine T1D care. In children with poorly controlled T1D and high healthcare utilization, we have demonstrated a high prevalence of adverse SDOH, which may represent a modifiable factor to improve outcomes in this patient population.
Description
Keywords
Social determinants , Type 1 diabetes , Socioeconomic status , Goals , Screening
Citation
Hershey, J. A., Morone, J., Lipman, T. H. and Hawkes, C. P. (2021) 'Social determinants of health, goals and outcomes in high-risk children with type 1 diabetes', Canadian Journal of Diabetes. doi: 10.1016/j.jcjd.2021.02.005