IDF21-0238 Socioeconomic Factors And Type 1 Diabetes Outcomes In A Universal Health Care System Context: A Better Registry Analysis

Abstract

Background: Lower socioeconomic status (SES) disparities resulting from the unequal distribution of social, environmental, and economic conditions, may add to the inherent challenges of type 1 diabetes (T1D) management. A Universal Health Care System (UHCS) offers the opportunity to address these disparities thus improving health outcomes. Aim: This study aims to evaluate the association between SES and diabetes management and acute complications in adults living with T1D. We hypothesize that even in a UHCS context; lower SES will be associated with a higher risk for suboptimal diabetes management and acute diabetes complications. Method: A cross-sectional analysis of self-reported data from a registry of people living with T1D (PWT1D) in Québec (Canada) to describe differences in SES factors; education (university level, associate degree, or ≤ highschool diploma), income (<30,000$, 30,000 to 60,000$, 60,000 to 100,000$, 100,000 to 150,000$ or >150,000$ CAD/year), employment (full time, part time, retired, unemployed, and other), insurance coverage (public, private, or a combination); and acute T1D outcomes (HbA1c levels, level 3-hypoglycemia (severe), and diabetes ketoacidosis (DKA) events in the past year; using χ2 tests and regression analysis (adjusted for age, sex, diabetes technology use, and SES factors). Results: Participants (n=1344; 62% women; 91% caucasian) aged 43±15 years; diabetes duration of 23±15 years and 71% reporting HbA1c ≤8.0%. The majority worked full time (57%), had private insurance (68%), at least an associate (38%) or a university degree (34%), and an average income between 30 and 60 000$ (20%) and 60 to 100 00$ CAD/year (26%). After adjustment, higher education level (university degree; OR: 0.468, 95% CI [0.322, 0. 816]; p=0.001) and yearly income (100 to 150 000$, OR: 0.496, 95% CI [0.318, 0.774]; p=0.002 and >150 000$, OR: 0.422, 95% CI [0.248, 0.718]; p=0.001) both remained associated with lower HbA1c levels when compared to ≤ Highschool diploma and lower income (≤30 000$). Participants with private insurance were less likely to report a history of DKA compared to participants using public coverage (adjusted OR: 0.250, 95% CI [0.143, 0.436], p<0.001). After adjustment, being employed (OR: 0.525, 95%CI [0.280, 0.986], p=0.045) and public insurance coverage (OR: 0.606, 95%CI [0.397, 0.926], p=0.021) remained significantly associated with decreased likelihood of having a severe hypoglycemia episode. Discussion: In a sample of relatively well-controlled PWT1D, HbA1c levels, severe hypoglycemia, and DKA incidence were lowest amongst participants with higher SES (employed, higher education, and income), compared to participants from lower SES. These findings, thus reflect a more challenging control in lower SES indicating that even in the context of a UHCS, which aims to improve access to healthcare, there are still areas to address to improve access to the same level of care for all.