Impact of Parental Socioeconomic Status on Excess Mortality in a Population-Based Cohort of Subjects With Childhood-Onset Type 1 Diabetes

Abstract

OBJECTIVE The aim of this study was to analyze the possible impact of parental and individual socioeconomic status (SES) on all-cause mortality in a population-based cohort of patients with childhood-onset type 1 diabetes. RESEARCH DESIGN AND METHODS Subjects recorded in the Swedish Childhood Diabetes Registry (SCDR) from 1 January 1978 to 31 December 2008 were included (n = 14,647). The SCDR was linked to the Swedish Cause of Death Registry (CDR) and the Longitudinal Integration Database for Health Insurance and Labour Market Studies (LISA). RESULTS At a mean follow-up of 23.9 years (maximum 46.5 years), 238 deaths occurred in a total of 349,762 person-years at risk. In crude analyses, low maternal education predicted mortality for male patients only (P = 0.046), whereas parental income support predicted mortality in both sexes (P < 0.001 for both). In Cox models stratified by age-at-death group and adjusted for age at onset and sex, parental income support predicted mortality among young adults (≥18 years of age) but not for children. Including the adult patient’s own SES in a Cox model showed that individual income support to the patient predicted mortality occurring at ≥24 years of age when adjusting for age at onset, sex, and parental SES. CONCLUSIONS Exposure to low SES, mirrored by the need for income support, increases mortality risk in patients with childhood-onset type 1 diabetes who died after the age of 18 years.

Socio‐economic factors influencing the development of end‐stage renal disease in people with Type 1 diabetes – a longitudinal population study

“…These results are in accordance with previous studies in which adults with Type 1 diabetes and low SES have been shown to have a higher risk of complications [19,20] and early death [21][22][23]. As a marker for SES, we used educational level and receipt of social support.…”

Socioeconomic Status and the Domestic Allocation of Type 1 Diabetes Care

“…Most importantly, their children had higher HbA1c levels. This finding is in keeping with larger studies on disparate outcomes in T1D for pediatric populations, with children in lower income households or with parents of low education levels suffering from a myriad of poor health indicators [22][23][24][25][26]. Thus, the benefit of male partners sharing in night-checks or "helping out" with diabetes care does not necessarily translate to improved HbA1c levels.…”

“…Service sector jobs that are commonplace for the working poor rarely allow for paid leave time to accommodate medical visits and render very low wages overall [20,21]. Given tremendous disparities in health outcomes in T1D associated with SES [22][23][24][25][26], it is crucial to examine how features of social context may impact decision-making related to diabetes care, and to identify challenges that may be unique to economically vulnerable families so interventions can be tailored accordingly.…”

Mental health visits and low socio‐economic status in adolescence are associated with complications of Type 1 diabetes in early adulthood: a population‐based cohort study

“…This corroborates the findings of Berhan et al . , who found that parental SES was associated with mortality in young adults (aged 18–24 years) diagnosed with Type 1 diabetes in childhood in Sweden . While Berhan et al .…”