Social determinants of health, goals and outcomes in high-risk children with type 1 diabetes

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dc.check.date2022-03-02
dc.check.infoAccess to this article is restricted until 12 months after publication by request of the publisher.en
dc.contributor.authorHershey, J. A.
dc.contributor.authorMorone, J.
dc.contributor.authorLipman, T. H.
dc.contributor.authorHawkes, Colin P.
dc.contributor.funderChildren’s Hospital of Philadelphiaen
dc.contributor.funderUniversity of Pennsylvaniaen
dc.date.accessioned2021-03-10T10:43:44Z
dc.date.available2021-03-10T10:43:44Z
dc.date.issued2021-03-02
dc.description.abstractIntroduction: 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.en
dc.description.sponsorshipChildren’s Hospital of Philadelphia (Chair’s Initiative Grant); University of Pennsylvania (School of Nursing Faculty Grant Award)en
dc.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationHershey, 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, 45(5), pp.444-450. https://doi.org/10.1016/j.jcjd.2021.02.005en
dc.identifier.doi10.1016/j.jcjd.2021.02.005en
dc.identifier.endpage450en
dc.identifier.issn1499-2671
dc.identifier.issued5en
dc.identifier.journaltitleCanadian Journal of Diabetesen
dc.identifier.startpage444en
dc.identifier.urihttps://hdl.handle.net/10468/11129
dc.identifier.volume45en
dc.language.isoenen
dc.publisherElsevier B.V.en
dc.rights© 2021, Canadian Diabetes Association. Published by Elsevier Ltd. All rights reserved. This manuscript version is made available under the CC BY-NC-ND 4.0 license.en
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.subjectSocial determinantsen
dc.subjectType 1 diabetesen
dc.subjectSocioeconomic statusen
dc.subjectGoalsen
dc.subjectScreeningen
dc.subject~Paediatrics and Child Health - Journal Articles~en
dc.titleSocial determinants of health, goals and outcomes in high-risk children with type 1 diabetesen
dc.typeArticle (peer-reviewed)en
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