Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
Can J Diabetes. 2022 Aug;46(6):586-593. doi: 10.1016/j.jcjd.2022.04.002. Epub 2022 Apr 12.
Social determinants of health (SDOH) are associated with type 1 diabetes (T1D) outcomes. Patient portal (PP) use can improve care quality. Therefore, equitable PP access is essential. Associations between SDOH and PP access have not been reported in pediatric T1D. The purpose of this study was to determine whether PP access and use are associated with SDOH in pediatric T1D.
This work was a cross-sectional study of patients <18 years of age with T1D who were seen in a diabetes clinic at a tertiary care centre between April 1, 2020, and March 31, 2021. Patient postal code, PP activation status and use, and characteristics were collected from electronic health records on April 1, 2021. SDOH were assessed using patient postal code linked to the Ontario Marginalization Index (ON-Marg) to determine quintile score across 4 dimensions of deprivation. Statistical analysis tested for an association between PP activation status and ON-Marg quintile.
Data were obtained for 634 patients with a mean age of 12.8±3.8 years; 53% were male and mean glycated hemoglobin was 8.4±2.0%. In the last year, 334 patients (53%) were PP active and 332 (52%) used the PP. The odds of inactive PP status were higher for those with the highest degree of material deprivation (odds ratio [OR], 2.91; 95% confidence interval [CI], 1.62 to 5.36) and residential instability (OR, 3.49; 95% CI, 1.86 to 6.70). PP activation status was not associated with dependency or ethnic concentration.
In our pediatric T1D population, inactive PP status is associated with greater material deprivation and residential instability. How these factors impact PP activation and how to improve equitable access requires further study.
健康的社会决定因素（SDOH）与 1 型糖尿病（T1D）的结果有关。患者门户（PP）的使用可以提高护理质量。因此，公平获得 PP 是至关重要的。在儿科 T1D 中，尚未报道 SDOH 与 PP 获得之间的关联。本研究的目的是确定儿科 T1D 患者的 PP 获得和使用是否与 SDOH 相关。
这是一项横断面研究，纳入了 2020 年 4 月 1 日至 2021 年 3 月 31 日期间在三级保健中心糖尿病诊所就诊的<18 岁 T1D 患者。于 2021 年 4 月 1 日从电子健康记录中收集患者的邮政编码、PP 激活状态和使用情况以及特征。使用患者邮政编码与安大略省边缘化指数（ON-Marg）相链接，评估 SDOH，以确定 4 个贫困维度的五分位数评分。统计分析测试了 PP 激活状态与 ON-Marg 五分位数之间的关联。
共纳入了 634 名患者的数据，平均年龄为 12.8±3.8 岁；53%为男性，平均糖化血红蛋白为 8.4±2.0%。在过去的一年中，有 334 名患者（53%）PP 活跃，332 名患者（52%）使用了 PP。物质剥夺程度最高的患者（比值比[OR]，2.91；95%置信区间[CI]，1.62 至 5.36）和居住不稳定（OR，3.49；95%CI，1.86 至 6.70）的患者，其 PP 无活动状态的可能性更高。PP 激活状态与依赖性或种族集中程度无关。
在我们的儿科 T1D 人群中，无活动的 PP 状态与更高的物质剥夺和居住不稳定有关。这些因素如何影响 PP 激活，以及如何改善公平获取，需要进一步研究。
