Evaluating Health Disparities in a Pediatric Population With Type 1 Diabetes

We sought to determine the association between SES and glycemic control in children with type 1 diabetes (T1D) followed at the Montreal Children’s Hospital (MCH), and whether insulin pump use, processes of care and depression modified the association. Using MCH’s Pediatric Diabetes Database, we conducted a retrospective cohort study of children ages 0 to 18 years diagnosed with T1D for at least a year with a visit between November 2019 and October 2020. Our outcome was mean glycated hemoglobin (HbA1c) in the following year. Our main exposure was socioeconomic status (SES; least deprived, moderately deprived, most deprived) measured by the Material and Social Deprivation Index. We used multivariable linear regression to determine the association between SES and HbA1c, adjusting for age, sex, diabetes duration, insulin pump use and processes of care. Interaction terms for insulin pump, processes of care and depression were included. A total of 306 children were identified. Children in the most deprived quintiles had higher mean HbA1c compared to those in the least deprived quintiles (p<0.01). HbA1c in the most deprived quintiles was 0.5% higher compared to the least deprived quintiles (95% confidence interval, 0.14 to 0.86). Effect modification by insulin pump, processes of care and depression was not significant. Consistent with previous findings, lower SES was associated with higher HbA1c. Our results are important for further research to understand contributing factors to these disparities.