934-P: HbA1c Trajectories across Childhood through Emerging Adulthood Vary as a Function of Race Crossed with Income, Education, and Type of Health Insurance

Abstract

Among youth with type 1 diabetes (T1D), non-Latino Whites, and those from higher socioeconomic status (SES) homes, typically show lower average HbA1c (A1c) levels, and slower deterioration in A1c across childhood through emerging adulthood. However, different SES metrics (income, educational achievement, type of health insurance) may have unique associations with T1D management, and the complex interplay between race/ethnicity and multiple SES metrics in T1D across development has yet to be systematically examined. This study investigated how a diverse sample of youth with T1D may vary in A1c across childhood through emerging adulthood as a function of multiple SES metrics. Medical records from a metropolitan clinic serving socioeconomically, ethnically, and racially diverse youth (N = 614; 36.7% Latino, 18.6% non-Latino White, 6.8% Black, 3% Asian/Pacific Islander, 35% Other Race/Multiracial; 48.9% Female) were coupled with US Census Tract data to index important measures of SES: Median neighborhood household income, % of the population with ≥ high school education (from US Census Tract data); type of health insurance: Private vs. Public/No Insurance (from medical records). Black youth had higher average A1c than Whites, Latinos, and Asian/Pacific Islanders, even after controlling for SES. Latinos had slower deterioration in A1c than all other racial groups across development, but this disappears after covarying SES. Income, education, and type of health insurance individually linked only to average A1c, with no associations to trajectories, but only insurance remained predictive of average A1c when all SES metrics are simultaneously covaried. Ethnic comparisons in average A1c and trajectories across development varied depending on income, education, and insurance status between groups, providing new insight for clinicians, researchers, and policymakers to help youth properly manage T1D. Disclosure D. Mello: None. J. Raymond: None. A. Torres sanchez: None. A. Main: None. D. Wiebe: None.