Background: T1D management and control in the year after diagnosis often establish long-term patterns for pediatric patients. Disparities in HbA1c based on race, ethnicity, and socioeconomic status (SES) are documented in the pediatric literature; yet there is limited description of the timeline in which these disparities appear.
Study Design: We conducted a retrospective chart review of patients diagnosed with T1D at a tertiary children’s hospital between 1/1/16 and 2/20/20 who received follow-up care for at least 1 year. Using zip-code level geocoding, we obtained community-level SES data based on American Community Survey (ACS) measures and classified patients according to the percent of families in census tract living in poverty, defined as 200% of the federal poverty level (FPL) .
Results: Of 758 patients, 15.6% (median, IQR 10.53, 24.01) of households were living in poverty; poor patients were defined as those in the upper quartile (>24.0% of households living below 200% of FPL) and rich patients in the lower quartile (<10.5%) . Patients from households in poor communities had higher HbA1c levels compared with their rich counterparts from baseline to 1-year post-diagnosis, although statistical differences emerged after 9 months between poor vs. rich groups: baseline 11.5% vs. 11.2%, p=0.10; 3 months 7.4% vs. 7.3%, p=0.62; 6 months 7.5% vs. 7.3%, p=0.24) ; 9 months 8.1% vs. 7.6%, p=0.01; and 1 year 8.2% vs. 7.8%, p=0.05.
Discussion: These data highlight the early origin of disparities in glycemic control in pediatric patients with T1D based on community-level SES. Understanding the time course of these disparate outcomes helps to inform the need for early intervention, particularly in low-income groups, to provide support likely needed to optimize glycemic control and long-term health outcomes. Further research can assess the overlapping axes of disparities that include race, ethnicity, and education level.
E.S.Tremblay: None. E.Liu: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc.