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J Pediatr. 2016 Oct;177:167-172. doi: 10.1016/j.jpeds.2016.06.049. Epub 2016 Jul 29.

Social Determinants of Health Are Associated with Modifiable Risk Factors for Cardiovascular Disease and Vascular Function in Pediatric Type 1 Diabetes.

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Department of Pediatrics, The Hospital for Sick Children & University of Toronto, Toronto, Ontario, Canada.
Department of Pediatrics, University of Cambridge, Cambridge, UK.
Institute of Child Health, University College London, London, UK.
Department of Pediatrics, The Hospital for Sick Children & University of Toronto, Toronto, Ontario, Canada. Electronic address:



To evaluate the relationship between social determinants of health (SDH) and cardiovascular disease (CVD) risk factors as well as a measure of arterial stiffness in adolescents with type 1 diabetes (T1D).


SDH were measured with the validated Ontario Marginalization Index, derived from deidentified postal code data and stratified by quintile (first  = least deprived; fifth = most deprived). SDH dimensions included material deprivation; ethnic concentration; and measures of dependency and residential instability. Metabolic control (hemoglobin A1c), cardiovascular risk metrics, and pulse wave velocity, as a measure of arterial stiffness, were related to SDH. Data were evaluated from a cohort of Canadian adolescents within the Adolescent Diabetes Cardiorenal Intervention Trial, a T1D clinical trial


A total of 704 participants were evaluated, and significant differences in hemoglobin A1c were evident at the extremes of material deprivation (8.4% vs 9.1% for least vs most deprived, P < .01). CVD risk factors were analyzed in 199 participants, with the most deprived reporting significantly less exercise (P = .004) and increased rates of smoking (P = .008). Increased material deprivation was associated with fewer metrics of "ideal" cardiovascular health attained. Arterial stiffness, as measured by pulse wave velocity, was associated positively with age, body mass index z score, and material deprivation.


Increased material deprivation was associated with poorer glycemic control. Modifiable, lifestyle-related risk factors for CVD and early arterial wall change are associated with SDH and represent a target for clinical intervention to reduce future CVD burden in adolescents with T1D.


cardiovascular risk; pediatrics; social determinants of health; type 1 diabetes

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