Racial-Ethnic Inequity in Young Adults With Type 1 Diabetes

被引:121
作者
Agarwal, Shivani [1 ]
Kanapka, Lauren G. [2 ]
Raymond, Jennifer K. [3 ]
Walker, Ashby [4 ]
Gerard-Gonzalez, Andrea [5 ]
Kruger, Davida [6 ]
Redondo, Maria J. [7 ]
Rickels, Michael R. [8 ]
Shah, Viral N. [5 ]
Butler, Ashley [7 ]
Gonzalez, Jeffrey [1 ,9 ]
Verdejo, Alandra S. [2 ]
Gal, Robin L. [2 ]
Willi, Steven [10 ]
Long, Judith A. [8 ,11 ]
机构
[1] Albert Einstein Coll Med, New York Reg Ctr Diabet Translat Res, Fle Inst Diabet & Metab, Div Endocrinol, Bronx, NY 10461 USA
[2] Jaeb Ctr Hlth Res, Tampa, FL 33647 USA
[3] Childrens Hosp Los Angeles, Los Angeles, CA 90027 USA
[4] Univ Florida, Gainesville, FL 32611 USA
[5] Univ Colorado, Barbara Davis Ctr Diabet, Anschutz Med Campus, Aurora, CO 80045 USA
[6] Henry Ford Med Ctr, Detroit, MI 48235 USA
[7] Texas Childrens Hosp, Baylor Coll Med, Houston, TX 77030 USA
[8] Univ Penn, Inst Diabet Obes & Metab, Perelman Sch Med, Philadelphia, PA 19104 USA
[9] Yeshiva Univ, Ferkauf Grad Sch Psychol, Bronx, NY 10461 USA
[10] Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA
[11] Corporal Michael J Crescenz VA Med Ctr, Philadelphia, PA 19104 USA
关键词
type; 1; diabetes; young adults; healthcare disparities; inequity; social determinants of health; OLDER MEXICAN-AMERICANS; US; ADOLESCENTS; CHILDHOOD; CARE; RACE/ETHNICITY; EXPERIENCES; TRANSITION; MORTALITY; CHILDREN;
D O I
10.1210/clinem/dgaa236
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context: Minority young adults (YA) currently represent the largest growing population with type 1 diabetes (T1D) and experience very poor outcomes. Modifiable drivers of disparities need to be identified, but are not well-studied. Objective: To describe racial-ethnic disparities among YA with T1D and identify drivers of glycemic disparity other than socioeconomic status (SES). Design: Cross-sectional multicenter collection of patient and chart-reported variables, including SES, social determinants of health, and diabetes-specific factors, with comparison between non-Hispanic White, non-Hispanic Black, and Hispanic YA and multilevel modeling to identify variables that account for glycemic disparity apart from SES. Setting: Six diabetes centers across the United States. Participants: A total of 300 YA with T1D (18-28 years: 33% non-Hispanic White, 32% non-Hispanic Black, and 34% Hispanic). Main Outcome: Racial-ethnic disparity in HbA1c levels. Results: Non-Hispanic Black and Hispanic YA had lower SES, higher HbA1c levels, and much lower diabetes technology use than non-Hispanic White YA (P < 0.001). Non-Hispanic Black YA differed from Hispanic, reporting higher diabetes distress and lower self-management (P < 0.001). After accounting for SES, differences in HbA1c levels disappeared between non-Hispanic White and Hispanic YA, whereas they remained for non-Hispanic Black YA (+ 2.26% [24 mmol/mol], P < 0.001). Diabetes technology use, diabetes distress, and disease self-management accounted fora significant portion of the remaining non-Hispanic Black-White glycemic disparity. Conclusion: This study demonstrated large racial-ethnic inequity in YA with T1D, especially among non-Hispanic Black participants. Our findings reveal key opportunities for clinicians to potentially mitigate glycemic disparity in minority YA by promoting diabetes technology use, connecting with social programs, and tailoring support for disease self-management and diabetes distress to account for social contextual factors.
引用
收藏
页码:E2960 / E2969
页数:10
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