IMPORTANCE Type 1 diabetes has been associated with cardiovascular disease and late complications such as retinopathy and nephropathy. However, it is unclear whether there is an association between type 1 diabetes and school performance in children. OBJECTIVE To compare standardized reading and mathematics test scores of schoolchildren with type 1 diabetes vs those without diabetes. DESIGN, SETTING, AND PARTICIPANTS Population-based retrospective cohort study from January 1, 2011, to December 31, 2015 (end date of follow-up), including Danish public schoolchildren attending grades 2, 3, 4, 6, and 8. Test scores were obtained in math (n = 524 764) and reading (n = 1 037 006). Linear regression models compared outcomes with and without adjustment for socioeconomic characteristics. EXPOSURES Type 1 diabetes. MAIN OUTCOMES AND MEASURES Primary outcomes were pooled test scores in math and reading (range, 1-100). RESULTS Among 631 620 included public schoolchildren, the mean (SD) age was 10.31 (SD, 2.42) years, and 51% were male; 2031 had a confirmed diagnosis of type 1 diabetes. Overall, the mean combined score in math and reading was 56.11 (SD, 24.93). There were no significant differences in test scores found between children with type 1 diabetes (mean, 56.56) and children without diabetes (mean, 56.11; difference, 0.45 [95% CI, −0.31 to 1.22]). The estimated difference in test scores between children with and without type 1 diabetes from a linear regression model with adjustment for grade, test topic, and year was 0.24 (95% CI, −0.90 to 1.39) and 0.45 (95% CI, −0.58 to 1.49) with additional adjustment for socioeconomic status. CONCLUSIONS AND RELEVANCE Among Danish public schoolchildren, there was no significant difference in standardized reading and mathematics test scores of children with type 1 diabetes compared with test scores of children without diabetes.
To examine inequality in glycemic control by maternal educational level among children with type 1 diabetes in a setting with universal access to health care. RESEARCH DESIGN AND METHODS This was a longitudinal nationwide study of 4,079 Danish children with type 1 diabetes between the years 2000 and 2013. Children were divided into four groups based on mothers' education prebirth (£high school [n = 1,643], vocational or 2-year college [n = 1,548], bachelor's degree [n = 695], ‡master's degree [n = 193]). Means of socioeconomic and treatment characteristics were compared between groups. HbA 1c and the number of daily glucose tests were compared repeatedly from onset until 5 years after onset across groups. HbA 1c was compared across daily blood glucose testing frequency and groups. Linear regression was used to compare HbA 1c across groups with and without adjustment for socioeconomic and treatment characteristics. RESULTS Large differences in HbA 1c across maternal education were found. The mean level of HbA 1c during follow-up was 59.7 mmol/mol (7.6%) for children of mothers with ‡master's degrees and 68.7 mmol/mol (8.4%) for children of mothers with £high school (difference: 9.0 mmol/mol [95% CI 7.5, 10.6]; 0.8% [95% CI 0.7, 1.0]). The associations were attenuated but remained significant after adjustment. Observable characteristics explained 41.2% of the difference in HbA 1c between children of mothers with £high school and mothers with ‡master's degree; 22.5% of the difference was explained by more frequent blood glucose monitoring among the children with the highly educated mothers. CONCLUSIONS Family background is significantly related to outcomes for children with type 1 diabetes, even with universal access to health care. Aspects of family background such as socioeconomic status (1,2), household composition (3-5), and ethnicity (1) have been linked to metabolic controlda key determinant of diabetes-related complications (6-9)din children with type 1 diabetes. Specifically, children with well-educated or affluent parents (1,2,10,11
Parental divorce is a prevalent childhood event. A long literature attempts to estimate the impact of family dissolution on children's human capital formation. Previous studies applying sibling xed eects estimators nd that the timing of divorce has no direct eects on children's outcomes and conclude that the observed raw associations between child age at parental divorce and adult outcomes are driven by selection of parents into divorce. We apply the same methods on new data sources consisting of the universe of all children that experienced parental divorces in Denmark from 1982 onwards. We nd small but precisely estimated negative average eects of early family dissolution on children's human capital formation measured from adolescence to the mid-twenties. By studying additional outcomes, we nd signicant evidence that parental divorce in early childhood leads to higher risk of mental health problems of children in adulthood. Furthermore, we nd suggestive evidence that the timing of divorce plays an especially pertinent role for boys and for children of highly educated parents.
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