Are social determinants of health associated with the development of early complications among young adults with type 2 diabetes? A population based study using linked databases. Issue 2 (April 2023)

• Record Type: Journal Article
• Authors: Nieuwenhuijse, Emma A.; van Hof, Teske B.; Numans, Mattijs.E.; Struijs, Jeroen N.; Vos, Rimke C.
• Is Part Of: Primary care diabetes. Volume 17:Issue 2(2023)
• Page Start: 168
• Page End: 174
• Publication Date: 2023-04
• Subjects: Type 2 diabetes -- Social determinants of health -- Young adults -- Diabetes complications -- Routine care data; Diabetes -- Periodicals; 616.462
• DOI: 10.1016/j.pcd.2023.01.002
• Languages: English
• ISSNs: 1751-9918

Abstract

Abstract: Aims: To quantify the impact of social determinants of health (SDOH) on top of medical determinants on the development of diabetes-related complications in young adults with type 2 diabetes. Methods: In this observational population-based study, SDOH (income and origin) were linked to routine primary care data. Young adults (18–45 years) with incident type 2 diabetes between 2007 and 2013 were included. The main outcome, the development of the first micro- or macrovascular complication, was analyzed by multivariate Cox regression. Medical determinants included antidiabetic treatment, HbA1c in the year after diagnosis, body mass index, comorbidity and smoking. Results: Of 761 young adults (median age: 39 years (IQR 33–42), men: 49%, Western origin: 36%, low income: 48%), 154 developed at least one complication (median follow-up 99 months (IQR 73–123)). Young men of non-Western origin were more likely to develop a complication (HR 1.98 (1.19–3.30)), as were young adults with HbA1c > 7% (>53 mmol/mol) (HR: 1.72 95% CI: 1.15–2.57). No associations were found with income. Being women was protective. Conclusion: In this multi-ethnic population, non-Western origin was associated with the development of complications, but only in men. Low income was not associated with developing complications. The importance of adequate HbA1c regulation was re-emphasized by this study. Highlights: Social disadvantage may be present in diabetes complications in young adults. Young men with non-Western origin were more likely to develop a complication. Income was not associated with diabetes complication development. Young adults with uncontrolled HbA1c were more likely to develop a complication. Proactive treatment should focus on HbA1c regulation in all at-risk populations.