Department of Social Work, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.
Yale University School of Medicine, New Haven, Connecticut, United States; Veterans Affairs Office of Academic Affiliations, West Haven, Connecticut, United States.
Can J Diabetes. 2021 Jul;45(5):444-450.e1. doi: 10.1016/j.jcjd.2021.02.005. Epub 2021 Mar 2.
Despite advances in technology and type 1 diabetes (T1D) care, children from low-income families continue to have suboptimal outcomes and increased health-care utilization. In this study, we describe social determinants of health (SDOH) in high-risk children with T1D, as well as their SDOH-related priority goals, and assess the correlation between SDOH, glycemic control and health-care utilization.
Caregivers of children aged 4 to 18 years with a diagnosis of T1D of >1 year, poor glycemic control (glycated hemoglobin [A1C] ≥9.5%) or high health-care utilization (≥2 diabetes-related hospitalizations, emergency department attendances or missed outpatient appointments in the previous year) were included. Primary caregiver health-related quality of life (HRQOL), self-efficacy (Maternal Self-Efficacy in Diabetes [MSED] scale) and SDOH were assessed. Goals were identified after assessment by a community health worker.
Fifty-three families were included, most (n=48, 91%) of whom had government insurance. Children had a median age of 13.4 (interquartile range [IQR], 12 to 15.3) years and a median A1C of 11.1% (IQR, 10% to 13%). Almost half of the families (n=24, 45%) reported at least 1 adverse SDOH. One or more adverse SDOH was associated with significantly lower total HRQOL scores (56.6 [IQR, 38.5 to 70.7] vs 77.8 [IQR, 60.8 to 92.4], p=0.004), but not associated with A1C (p=0.3), emergency department visits (p=0.9) or MSED (p=0.5).
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 health-care utilization, we have demonstrated a high prevalence of adverse SDOH, which may represent a modifiable factor to improve outcomes in this patient population.
尽管在技术和 1 型糖尿病（T1D）治疗方面取得了进步，但来自低收入家庭的儿童仍然存在治疗效果不理想和医疗保健利用率增加的情况。在这项研究中，我们描述了高危 T1D 儿童的健康社会决定因素（SDOH），以及他们与 SDOH 相关的优先目标，并评估了 SDOH、血糖控制和医疗保健利用之间的相关性。
纳入了年龄在 4 至 18 岁之间、T1D 诊断时间超过 1 年、血糖控制不佳（糖化血红蛋白 [A1C]≥9.5%）或医疗保健利用率高（过去一年中≥2 次糖尿病相关住院、急诊就诊或错过门诊预约）的儿童的主要照顾者。评估了主要照顾者的健康相关生活质量（HRQOL）、自我效能（母亲糖尿病自我效能量表[MSED]）和 SDOH。在社区卫生工作者评估后确定了目标。
共纳入 53 个家庭，其中大多数（n=48，91%）有政府保险。儿童的中位年龄为 13.4 岁（四分位距[IQR]，12 至 15.3），A1C 中位数为 11.1%（IQR，10%至 13%）。近一半的家庭（n=24，45%）报告存在至少 1 种不利的 SDOH。1 种或多种不利的 SDOH 与总 HRQOL 评分显著降低相关（56.6 [IQR，38.5 至 70.7] 与 77.8 [IQR，60.8 至 92.4]，p=0.004），但与 A1C （p=0.3）、急诊就诊（p=0.9）或 MSED （p=0.5）无关。
筛查不利的 SDOH 并解决血糖控制的这些障碍不是 T1D 常规治疗的一部分。在血糖控制不佳且医疗保健利用率高的 T1D 儿童中，我们发现不利的 SDOH 患病率较高，这可能是改善该患者人群结局的一个可改变因素。
