Social determinants impacting health has been widely established in the pediatric population, but there is a paucity in the literature quantifying psychosocial stressors in children with chronic conditions. We administered the Pediatric Adverse Childhood Experiences and Related Life Events Screener (PEARLS) to a cohort of pediatric patients with type 1 diabetes (T1D), with at least 1 year duration, at UCSF Benioff Children’s Hospital Oakland. This two-section validated survey quantifies experiences such as (but not limited to): Section 1 (S1), abuse, neglect, and domestic dysfunction and Section 2 (S2), domestic hardship (eg food scarcity, housing). Our cohort included 38 males and 43 females, aged 4 to 21 years old. Scored surveys were compared to social determinants (insurance status, clinic location, and race) and health factors (HbA1c and BMI). Statistical analyses were performed using t-tests, chi-square tests, and multivariate regression models. Results revealed an average PEARLS score for the group as 1.16 ±1.79 and 0.63 ±1.05 for S1 and S2 respectively. There was a statistical difference between Caucasians and non-Caucasians for S1 (p=0.01), and for those patients who were seen in Oakland versus an upper-middle-class suburban clinic (San Ramon, CA) for both Sections (p=0.01 and p=0.007, for S1 and S2 respectively). For those with a HbA1c > 10% there was a statistical difference for S2 (p=0.004). This is the first study quantifying adverse childhood experiences in a T1D cohort, as far as we know. As a group, those with T1D do not experience significant toxic stress, but statistically relevant risk factors for elevated PEARLS scores included being non-caucasian, having a HbA1c > 10% and being seen in an urban clinic. Implementation of the PEARLS survey can help providers and diabetes care teams focus on stressors that may be impeding glycemic control and impacting current and future health, particularly in those risk groups mentioned prior. Use of larger cohorts may elucidate other associations.


E. Zakheim: None. G. Gildengorin: None. T. Ahmad: None.

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