Original ArticleSocial Determinants of Health on Glycemic Control in Pediatric Type 1 Diabetes
Section snippets
Methods
We conducted a cross sectional study linking de-identified patient data with publicly available data sets of the Institut national de santé publique du Québec-DI (INSPQ-DI), measuring Material and Social Deprivation,13, 18, 19, 20 and the Ontario Marginalization Index (ON-Marg), measuring Ethnic Concentration.21
All patients diagnosed with T1D for ≥1 year who were followed at SickKids between August 2010 and August 2011 were included in our analysis. Information on patient postal code, age, sex,
Results
DAs were determined for 854 patients with T1D. Forty patients were excluded as their postal code did not correspond to a DA or was inconsistent throughout the study period. Patients had a mean age (±SD) of 12.6 ± 4.2 years (IQR, 9.7-16.0 years), 48.2% were female, and 32.3% were on insulin pump therapy. Patients who were not on insulin pump had variable insulin regimens. The mean A1C (±SD) for our patient population was 8.7% ± 1.5%, based on a median of 3 A1C levels (IQR = 2-4) measured over
Discussion
The greater concentration of our T1D population in the 2 extremes of Material Deprivation, compared with the background population of Toronto, is likely multifactorial. This may reflect referral patterns based upon the status of our hospital as the largest pediatric center in the city, which attracts affluent patients seeking high-level care, and our location in the downtown core, which is more accessible by public transportation from urban and suburban areas. The overall material divide in our
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The authors declare no conflicts of interest.