Socioeconomic deprivation independently predicts symptomatic painful diabetic neuropathy in type 1 diabetes

Anderson, Simon; Malipatil, Nagaraj; Roberts, Hugh; Dunn, George A.; Heald, Adrian

doi:10.1016/j.pcd.2013.08.004

Cited by 11 publications

(12 citation statements)

References 7 publications

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“…An association between low SES and increased rates of complications arising from diabetes was observed in 5 studies [21;31;39;43;44]. Complications investigated included: renal disease [21;39;43;44]; proliferative retinopathy [31;39;43]; blindness [44]; lower extremity arterial disease [21;39;43]; painful neuropathy [14] and autonomic neuropathy [21]. …”

Section: Resultsmentioning

confidence: 99%

“…Six studies found SES was an independent predictor of long-term complications arising from type 1 diabetes [14;18;21;31;43;44]. Following adjustments for other risk factors including age, diabetes duration, sex, and BMI, low SES was significantly associated with severe hypoglycaemia in one study [42] and both severe hypoglycaemia and ketoacidosis in another study [22].…”

Section: Resultsmentioning

confidence: 99%

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Socioeconomic inequalities in mortality, morbidity and diabetes management for adults with type 1 diabetes: A systematic review

et al. 2017

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AimsTo systematically review the evidence of socioeconomic inequalities for adults with type 1 diabetes in relation to mortality, morbidity and diabetes management.MethodsWe carried out a systematic search across six relevant databases and included all studies reporting associations between socioeconomic indicators and mortality, morbidity, or diabetes management for adults with type 1 diabetes. Data extraction and quality assessment was undertaken for all included studies. A narrative synthesis was conducted.ResultsA total of 33 studies were identified. Twelve cohort, 19 cross sectional and 2 case control studies met the inclusion criteria. Regardless of healthcare system, low socioeconomic status was associated with poorer outcomes. Following adjustments for other risk factors, socioeconomic status was a statistically significant independent predictor of mortality in 9/10 studies and morbidity in 8/10 studies for adults with type 1 diabetes. There appeared to be an association between low socioeconomic status and some aspects of diabetes management. Although only 3 of 16 studies made adjustments for confounders and other risk factors, poor diabetes management was associated with lower socioeconomic status in 3/3 of these studies.ConclusionsLow socioeconomic status is associated with higher levels of mortality and morbidity for adults with type 1 diabetes even amongst those with access to a universal healthcare system. The association between low socioeconomic status and diabetes management requires further research given the paucity of evidence and the potential for diabetes management to mitigate the adverse effects of low socioeconomic status.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Socioeconomic inequalities in mortality, morbidity and diabetes management for adults with type 1 diabetes: A systematic review

et al. 2017

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“…Access to a GP or hospital clinic was not associated with foot ulceration or amputation. We have previously shown that socially disadvantaged individuals have a predisposition to developing painful peripheral neuropathy, an important determinant of foot ulceration in both type 1 and type 2 diabetes [40]. Regarding the increased death rate in individuals with an established foot ulcer, the dominant prognostic factor may be the effect of social disadvantage [41,42].…”

Section: Discussionmentioning

confidence: 99%

Social deprivation modifies the association between incident foot ulceration and mortality in type 1 and type 2 diabetes: a longitudinal study of a primary-care cohort

et al. 2017

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Aims/hypothesis The aim of this study was to determine whether social deprivation in the presence of diabetes is an independent predictor of developing a foot ulcer and separately of mortality. Methods This was a primary-care-based retrospective analysis of 13,955 adults with type 1 (n = 1370) or type 2 (n = 12,585) diabetes after a median follow-up of 10.5 years. Demographic characteristics, indices of social deprivation and clinical variables were assessed at baseline. The primary outcomes were new foot ulceration (in those without a previous history of foot ulcers) and all-cause mortality. Cox proportional hazard models were used to describe the associations among foot ulceration, social deprivation and mortality. Results The mean age of the population was 69.4 (range: 16-89) years. The incidence of foot ulceration was greater in individuals with type 2 (8.6%) compared with type 1 diabetes (4.8%). Occurrence was similar by sex, but increased with age and deprivation index. Individuals in the highest quintile of deprivation were 77% more likely to develop a foot ulcer compared with those in the lowest quintile (OR 1.77 [95% CI 1.45, 2.14], p < 0.0001). Overall, 2946 (21.1%) deaths were recorded. Compared with individuals without a foot ulcer, the development of a foot ulcer was associated with a higher age-and sex-adjusted mortality rate (25.9% vs 14.0%), and a 72% (HR Conclusions/interpretation This study confirms the high mortality rate in individuals with diabetes-related foot ulcers. In addition, socioeconomic disadvantage was found to be an independent effect modifier, contributing to an increased burden of mortality in people with diabetes who develop foot ulceration. In light of this, and as diabetes service configurations are orientated for the next 5-10 years, modelling of foot ulceration risk needs to take socioeconomic disadvantage into account.

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“…Patients who live below the federal poverty line and hold minority-group status are more likely to have poorer outcomes in chronic yet common conditions such as diabetes(1), hypertension(2-4), hypercholesteremia(5-7), osteoporosis (8,9), and depression (10,11). Underserved populations also have a greater prevalence of poorer outcomes in complications such as kidney disease (12)(13)(14), neuropathy (15), strokes (16), cardiac failure (17,18), and atherosclerosis (19), as well as outcome imbalances in cancer diseases such as breast cancer, lung cancer, and colon cancer (20,21). Since preventive medicine can significantly reduce the burden of these diseases, increasing its access to impoverished or neglected populations is paramount (22).…”

Section: Introductionmentioning

confidence: 99%

Negative health outcomes associated with food insecurity status in the United States of America: A systematic review of peer-reviewed studies

Arenas¹,

Zhou²,

Thomas³

et al. 2018

Preprint

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Introduction: Social determinants of health, such as food security, are an important target for health providers, particularly in the care of patients from underserved populations, including the uninsured and socially marginalized. Preliminary research has shown that food insecurity status (FIS) is associated with negative health outcomes.Objective: We aim to present a concise, yet comprehensive resource that lists the health outcomes associated with FIS. This guide is meant to provide innovative health providers with the tools needed to justify the importance of using FIS screening and treatment as a preventive medicine intervention.Methods: We conducted a systematic review of peer-reviewed manuscripts that studied FIS in the United States of America (USA) and at least one health outcome. We searched PubMed, Embase, Web of Science, and Scopus and had multiple reviewers examine each abstract and manuscript. We only retained peer-reviewed studies that contained USA data, directly measured FIS, and directly compared FIS to a health outcome.Results: The initial search yielded 1,817 manuscripts. After screening abstracts for duplicates and inclusion criteria, a total of 117 manuscripts were retained and fully examined. Several manuscripts showed significant association between FIS and neurologic, cardiac, endocrine, and pulmonary health outcomes. Studies in the USA population show robust associations between FIS and poor mental health (including depression, anxiety, sleep disorders, impaired cognitive functioning, and epilepsy), metabolic syndrome, hyperlipidemia, greater risk for bone fracture in children, higher risk of end-stage renal disease in patients with chronic kidney disease, self-reported poor health, and higher mortality in patients with the human immunodeficiency virus. Though other literature reviews show positive associations between FIS and health outcomes such as diabetes, body mass index, and hypertension, our systematic review showed mixed results.Conclusions: FIS leaves underserved populations at risk for negative health outcomes. More research should be done to examine the effects of FIS alleviation as a preventative medicine intervention.

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Socioeconomic deprivation independently predicts symptomatic painful diabetic neuropathy in type 1 diabetes

Cited by 11 publications

References 7 publications

Socioeconomic inequalities in mortality, morbidity and diabetes management for adults with type 1 diabetes: A systematic review

Socioeconomic inequalities in mortality, morbidity and diabetes management for adults with type 1 diabetes: A systematic review

Social deprivation modifies the association between incident foot ulceration and mortality in type 1 and type 2 diabetes: a longitudinal study of a primary-care cohort

Negative health outcomes associated with food insecurity status in the United States of America: A systematic review of peer-reviewed studies

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