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Low Income Increases Mortality Risk In Type 1 Diabetes

Exposure to low socioeconomic status appears to increase the risk for death in patients diagnosed with type 1 diabetes during childhood who died after age 18 years…

This should add more incentive to make the social worker part of the diabetes team.

The researchers wrote, “The current study indicates that having parents with low socioeconomic status leads to additional excess mortality among young adults with childhood-onset type 1 diabetes.”

Yonas T. Berhan, of the department of clinical sciences in pediatrics at Umeå University, and colleagues analyzed data on 14,647 patients with childhood-onset type 1 diabetes from the Swedish Childhood Diabetes Registry (1978-2008) to assess the impact of parental and individual socioeconomic status on all-cause mortality.

Using unique personal identification numbers, the investigators linked the diabetes registry to the Swedish Cause of Death Registry and the Longitudinal Integration Database for Health Insurance and Labor Market Studies. Data on educational level and need for income support through the Swedish social welfare system were gathered for parents and patients from 1990 to 2010.

During an average follow-up of 24 years, 238 deaths occurred in 349,762 person-years at risk. In crude analyses, low maternal education predicted death for men (P = .046) and parental income support predicted death for both men and women (P < .001 for both).

Using Cox models stratified by age at death and adjusted for age at onset and sex, parental income support predicted death among young adults aged at least 18 years, but not children.

When socioeconomic status for adult patients was included in Cox models, income support to the patient predicted death at age 24 years or older, with adjustments for age at onset, sex and parental socioeconomic status.

“Diabetes care teams should be aware of this problem and make efforts to minimize these effects,” the researchers wrote. “Social workers should preferentially be involved on the diabetes team during both childhood and adulthood.”

Practice Pearls:

  • In analyses, low maternal education predicted death for men (P = .046).
  • Parental income support predicted death for both men and women (P < .001 for both).
  • The study results show that we need to consider making the social worker part of the diabetes team.

Berhan YT, et al. Diabetes Care. 2015;doi:10.2337/dc14-1522. February 25, 2015.