Background: For teens with T1D, stress related to neighborhood disadvantage may exacerbate diabetes distress and contribute to disparities in care and outcomes.
Objective: We explored associations among neighborhood disadvantage and clinical/psychosocial outcomes to identify patterns to inform future stress-resilience interventions.
Methods: At baseline of a 2-site psychosocial intervention trial, 173 teens aged 13-18 years with T1D ≥1 year and elevated diabetes distress (57% Female, 2% American Indian/Alaska Native, 4% Asian, 15% Black, 11% Hispanic White, 6% Hispanic Non-White, 63% Non-Hispanic White, mean A1c= 8.7±2.1, 66% pump use) completed a demographics form and measures of resilience, diabetes distress, diabetes quality of life and family conflict.. We retrieved area deprivation index (ADI) scores for home addresses; this measure of neighborhood disadvantage considers factors related to income, education, employment, and housing quality at the census block group level and provides a state-relative decile score (higher scores indicate more disadvantage) . Fisher’s exact tests and regression analyses were used to examine associations of ADI with A1c and survey data.
Results: Participant ADI spanned all deciles, M = 3.7± 2.4. Hispanic White/Non-White and Black teens and those not using pump had higher mean ADI. Higher ADI was associated with higher A1c (β=.18 [.06, 0.29], p=.003) and higher family conflict (β=.63 [.12, 1.1], p=.015) . ADI was not significantly related to resilience, diabetes distress, or quality of life.
Conclusions: In a diverse sample of distressed teens with T1D, neighborhood disadvantage was associated with Hispanic ethnicity and Black race, lower pump use, poorer glycemic control and greater family conflict. Considering neighborhood disadvantage may help providers deliver personalized care to target systemic sources of stress, ultimately improving clinical and psychosocial outcomes.
M.B.O'donnell: None. M.E.Hilliard: None. J.Yi-frazier: None. B.Duran: None. C.Zhou: None. F.Malik: n/a. C.Pihoker: None. S.R.Scott: None. B.M.Ellisor: None. S.Garcia perez: None. D.Desalvo: Consultant; Dexcom, Inc., Insulet Corporation, Research Support; Insulet Corporation.
US National Institutes of Health R01DK121224