Economic status, poor mental health predict young adult diabetic complications
medwireNews: Low socioeconomic status and mental health visits during adolescence are associated with an increased risk for diabetes-related complications and death in early adulthood, Canadian researchers report.
Rayzel Shulman (University of Toronto, Ontario) and team therefore call for evaluation of “[t]argeted interventions to prevent adverse events in this extremely vulnerable group.”
The population-based cohort study included 8491 individuals from Ontario, who had their 20th birthday between January 1999 and March 2015 and were diagnosed with diabetes before their 15th birthday.
During a median 6.5 years of follow-up, 127 study participants died, giving a mortality rate of 2.14 per 1000 person–years.
The researchers report that the individuals with diabetes had a significant 4.27-fold increased risk for death when compared with 42,455 age- and gender-matched controls who did not have diabetes.
Among the individuals with diabetes, those with parents in the most deprived quintile for socioeconomic status at age 15 years (13.9%) had double the risk for death (hazard ratio [HR=2.03]) compared with those with parents in the least deprived quintile (24.5%).
In addition, individuals with diabetes who had a mental health visit between the ages of 15 and 20 years (40.4%) had a significant 2.45-fold increased risk for death during follow-up compared with those with no mental health visit.
High deprivation and mental health visits were also associated with significantly increased risks for acute and chronic diabetes complications.
Specifically, individuals in highest deprivation quintile who also had a mental health visit between the ages of 15 and 20 years had significant 4.84- and 3.15-fold increased risks for diabetes-related hospitalizations and emergency department visits, respectively, compared with those who were least deprived with no mental health visits.
The risk for any chronic complication was a significant 1.54-fold higher in individuals with the highest versus lowest deprivation level and a significant 1.57-fold higher in those with versus without a mental health visit.
Writing in Diabetic Medicine, Shulman and co-authors remark: “The problems facing this high-risk population are complex, extend beyond healthcare, and may traverse multiple governmental domains, including children’s services, social services, education, housing and labour.
“Yet, there is a lack of attention to transition of care for young people with chronic medical conditions in health or broader social policy, suggesting a need for cross-sectoral governance and collaboration to effect change,” they conclude.
By Laura Cowen
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