1320-P: Causal Mediators of Underlying Socioeconomic Status Disparities in Hospitalization Risk among Patients with Type 2 Diabetes (T2D)

Abstract

Socioeconomically disadvantaged groups carry a disproportionally increased risk of T2D-related adverse outcomes, yet few studies have addressed how modifiable social risk factors drive such health disparities. We aimed to estimate to what extent housing instability explained unemployment or education disparities in hospitalization risk in patients with T2D. We used electronic health records data from the University of Florida Health System and identified patients with T2D in 2015-2020. We conducted causal mediation analyses using marginal structural models to test the causal mediator role of housing insecurity in the association between education or employment and hospitalization risk. Of 9,144 eligible patients, mean (SD) age was 58 (13) years, and 17% were hospitalized in the follow-up year. We observed an increased hospitalization risk in those who were unemployed (odds ratio [OR]: 1.21, 95% CI: 1.04-1.41) and those with lower education levels (1.38 [1.17-1.62]). Housing insecurity, as a causal mediator, explained 11% of the unemployment-hospitalization association, but it had minimal contribution to the education-hospitalization association (2%). Unemployment status and lower education were associated with an increased risk of hospitalization in T2D. Housing insecurity modestly contributed to unemployment disparities in hospitalization risk in T2D. Disclosure W.Chen: None. Y.Huang: None. W.T.Donahoo: None. J.Bian: None. J.Guo: Consultant; Pfizer Inc., Research Support; PhRMA Foundation, NIH - National Institutes of Health. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK133465)