Endocrinology and Diabetes Service, Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, University of Montréal, Montréal, Canada H3T 1C5.
J Clin Endocrinol Metab. 2013 May;98(5):E882-5. doi: 10.1210/jc.2013-1212. Epub 2013 Mar 28.
In health care systems with a user fee, the impact of socioeconomic factors on pediatric insulin-dependent diabetes mellitus (IDDM) control could be due to the cost of accessing care.
There is a linear association between household income and the average glycosylated hemoglobin (HbA1c) of children and adolescents with IDDM despite free access to health care.
We used a linear regression model to examine the association between normalized average HbA1c of 1766 diabetic children (diagnosed at our institution from 1980 to 2011 before 17 years of age) and the median household income of their neighborhoods (obtained from Statistics Canada, 2006 Census data).
We found a negative linear association (P < .001; r = -0.2) between the level of income and metabolic control assessed by HbA1c after controlling for sex, age at diagnosis, duration of diabetes, ethnicity, geographical factors, frequency of visits, current age (as a proxy for change in practice over time), and change of measurement methods of HbA1c across time. For every increase of $15,000 in annual income, HbA1c decreased by 0.1%.
We report a linear association of household income with metabolic control of IDDM in childhood. Given that Canada has a system of free universal access to health care, confounding by access to care is unlikely. Considering the impact of poorly controlled IDDM in childhood on the development of long-term complications, our findings suggest that the higher complication rate found in adults of low socioeconomic status might originate from the poor control that they experienced in childhood. Support for the care of IDDM children from low-income neighborhoods should be increased.
在实行按人收费的医疗保健系统中，社会经济因素对儿童胰岛素依赖型糖尿病（IDDM）控制的影响可能归因于获得医疗保健的费用。
尽管可以免费获得医疗保健，但家庭收入与 IDDM 儿童和青少年的平均糖化血红蛋白（HbA1c）之间存在线性关联。
我们使用线性回归模型来检验 1766 名糖尿病儿童（1980 年至 2011 年在我们机构确诊，年龄在 17 岁之前）的平均 HbA1c 与他们居住社区的家庭收入中位数之间的关系（从加拿大统计局的 2006 年人口普查数据中获得）。
在控制了性别、诊断时年龄、糖尿病病程、种族、地理因素、就诊频率、当前年龄（作为随时间推移实践变化的替代指标）和 HbA1c 测量方法的变化后，我们发现收入水平与通过 HbA1c 评估的代谢控制之间存在负线性关联（P <.001；r = -0.2）。每年收入增加$15,000，HbA1c 降低 0.1%。
我们报告了家庭收入与儿童期 IDDM 代谢控制之间的线性关联。鉴于加拿大实行免费全民医疗保健制度，因此不太可能存在获得医疗保健的混杂因素。考虑到儿童期控制不佳的 IDDM 对长期并发症发展的影响，我们的发现表明，社会经济地位较低的成年人中发现的较高并发症发生率可能源于他们在儿童期经历的较差控制。应该增加对低收入社区 IDDM 儿童的关怀支持。
