Ding Xiyu, Kharrazi Hadi, Nishimura Akihiko
Biomedical Informatics and Data Science, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States.
JAMIA Open. 2024 Oct 25;7(4):ooae107. doi: 10.1093/jamiaopen/ooae107. eCollection 2024 Dec.
Adverse Social Determinants of Health (SDoH) are considered major obstacles to effective management of type-2 diabetes. This study aims to quantify the impact of SDoH factors on diabetes management outcomes.
We quantified the joint impact of multiple SDoH by applying a self-control case series method-which accounts for confounding by using individuals as their own control-to electronic health record data from an academic health system in Maryland.
We found a consistent increase in HbA1c levels associated with SDoH across alternative study designs. The estimated total contributions of SDoH ranged 0.014-0.065 across the alternative designs. Transportation issues demonstrated particularly significant contributions, with estimates of 0.077-0.144. When assuming SDoH's risk window to be ±45 days, for example, the total contribution was estimated to be 0.065 (95% CI [0.010, 0.120]) increase in HbA1c and the transportation issues' contribution 0.134 (95% CI [0.020, 0.249]).
Our result suggests that reducing transportation barriers may be an effective SDoH intervention strategy for diabetes management; however, the clinical impact of such interventions warrants further investigation.
健康的不良社会决定因素（SDoH）被认为是有效管理2型糖尿病的主要障碍。本研究旨在量化SDoH因素对糖尿病管理结果的影响。
我们通过应用自我对照病例系列方法——该方法通过将个体作为自身对照来解释混杂因素——对来自马里兰州一个学术医疗系统的电子健康记录数据进行分析，从而量化多种SDoH的联合影响。
在不同的研究设计中，我们发现与SDoH相关的糖化血红蛋白（HbA1c）水平持续上升。在不同设计中，SDoH的估计总贡献范围为0.014 - 0.065。交通问题显示出特别显著的贡献，估计值为0.077 - 0.144。例如，当假设SDoH的风险窗口为±45天时，估计糖化血红蛋白的总贡献为增加0.065（95%置信区间[0.010, 0.120]），交通问题的贡献为0.134（95%置信区间[0.020, 0.249]）。
我们的结果表明，减少交通障碍可能是糖尿病管理中一种有效的SDoH干预策略；然而，此类干预措施的临床影响值得进一步研究。
