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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.

Author information

1
Department of Pediatrics, The Hospital for Sick Children & University of Toronto, Toronto, Ontario, Canada.
2
Department of Pediatrics, University of Cambridge, Cambridge, UK.
3
Institute of Child Health, University College London, London, UK.
4
Department of Pediatrics, The Hospital for Sick Children & University of Toronto, Toronto, Ontario, Canada. Electronic address: Farid.mahmud@sickkids.ca.

Abstract

OBJECTIVE:

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).

STUDY DESIGN:

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

RESULTS:

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.

CONCLUSION:

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.

KEYWORDS:

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

PMID:
27476636
DOI:
10.1016/j.jpeds.2016.06.049
[Indexed for MEDLINE]

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