Periodontal treatment provided to mothers with mild to moderate periodontal disease before 21 weeks of gestation may prevent preterm births.
Objective: Health inequities persist in youth and young adults (YYA) with type 1diabetes in achieving optimal glycemic control. The purpose of this study was to assess the contribution of multiple indicators of social need to these inequities. Research design and methods: Two hundred and twenty two YYA withtype 1 diabetes enrolled in the SEARCH Food Insecurity Study in South Carolina and Washington between the years 2013 and 2015 were included. Latent class analysis was used to identify socioeconomic profiles based on household income, parental education, health insurance, household food insecurity, and food assistance. Profiles were evaluated in relation to glycemic control using multivariable linear and logistic regression, with HbA1c > 9%(75 mmol/mol) defined as high-risk glycemic control. Results: Two profiles were identified: a lower socioeconomic profile included YYA whose parents had lower income and/or education, and were more likely to be uninsured, receive food assistance, and be food insecure. A higher socioeconomic profile included YYA whose circumstances were opposite to those in the lower socioeconomic profile. Those with a lower socioeconomic profile were more likely to have high-risk glycemic control relative to those with a higher socioeconomic profile (OR = 2.24, 95%CI = 1.16-4.33). Conclusions: Lower socioeconomic profiles are associated with high-risk glycemic control among YYA with type 1 diabetes. This supports recommendations that care providers of YYA with type 1 diabetes assess individual social needs in tailoring diabetes management plans to the social context of the patient.
Affordability and geographic accessibility are key health care access characteristics. We used data from 481 youth and young adults (YYA) with diabetes (389 type 1, 92 type 2) to understand the association between health care access and glycemic control as measured by HbA1c values. In multivariate models, YYA with state or federal health insurance had HbA1c percentage values 0.68 higher (P = 0.0025) than the privately insured, and those without insurance 1.34 higher (P < 0.0001). Not having a routine diabetes care provider was associated with a 0.51 higher HbA1c (P = 0.048) compared to having specialist care, but HbA1c did not differ significantly (P = 0.069) between primary vs specialty care. Distance to utilized provider was not associated with HbA1c among YYA with a provider (P = 0.11). These findings underscore the central role of health insurance and indicate a need to better understand the root causes of poorer glycemic control in YYA with state/federal insurance.
Background and Purpose: We investigated the prevalence, awareness, and control of vascular risk factors (VRFs) and the use of antithrombotic and statin agents in HCHS (Hispanic Community Health Study)/SOL (Study of Latinos) participants with self-reported history of stroke or transient ischemic attack. Methods: Sociodemographic characteristics, medications, and prevalence of different VRFs were recorded. VRF diagnoses and goals were based on the recommendations of professional organizations. Factors associated with optimal VRF control and use of antithrombotic and statin agents were investigated using multivariate logistic regression. Results: The analysis included 404 participants (39% men). The prevalences of hypertension, dyslipidemia, and diabetes were 59%, 65%, and 39%, respectively. Among those who met the diagnostic criteria for these diagnoses, the frequencies of awareness were 90%, 75%, and 83%, respectively. In participants who were aware of their VRFs, the prevalences of controlled hypertension, dyslipidemia, and diabetes were 46%, 32%, and 54%. Approximately 46% of the participants were on antithrombotics, 39% on statins, and 26% on both. Only 38% of those with atrial fibrillation received anticoagulation. In multivariate analyses adjusted for baseline sociodemographic characteristics, older age was associated with uncontrolled hypertension and diabetes. Residing in the United States for ≥10 years and born in the United States were associated with uncontrolled diabetes, female sex with uncontrolled dyslipidemia, and lack of health insurance with decreased use of statins and hyperlipidemia. Conclusions: Hispanic/Latino adults in the United States have high prevalence and awareness of VRFs but low adherence to secondary stroke prevention strategies. Older adults, women, and uninsured people are vulnerable groups that may benefit from targeted interventions. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02060344.
Various measures of socioeconomic status (SES) predict glycemic control in youth and young adults (YYA) with type 1 diabetes; however, rarely have multiple SES factors been considered simultaneously, including parental education and income, food security, health insurance status, and food assistance. The purpose of this study was to identify multidimensional SES profiles in YYA with type 1 diabetes and to assess the association between these profiles and glycemic control. Data from 257 YYA with type 1 diabetes enrolled in the SEARCH Food Insecurity Ancillary Study in South Carolina and Washington between the years 2013 and 2015 were included. We identified SES profiles utilizing latent class analysis and used multivariable logistic regression to compare the profiles’ glycemic control, with HbA1c > 9% defined as poor glycemic control. Two profiles were identified: Profile 1 (74%) included YYA that were of higher parental income and education, and less likely to have government-funded health insurance, to receive food assistance, and to be food insecure. Profile 2 (26%) included YYA who were categorized opposite to that of profile 1. In profile 2, 60% of YYA had poor glycemic control compared to 44% of YYA in profile 1. After adjustment for age, sex, race/ethnicity, site, diabetes duration, and diabetes medication, YYA in profile 2 were significantly more likely to have poor glycemic control relative to YYA in profile 1 (OR = 1.94, 95% CI = 1.01-3.71). Membership to a lower SES profile is associated with poor glycemic control among YYA with T1D. Strategies to improve glycemic control, particularly in YYA who belong to lower SES profiles, are needed. Disclosure M.W. Sutherland: None. X. Ma: None. J.A. Mendoza: None. B.A. Bell: None. B.A. Reboussin: None. A.R. Kahkoska: None. K.A. Sauder: None. C. Pihoker: None. A.D. Liese: None.
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