Social Determinants of Health Are Associated with Modifiable Risk Factors for Cardiovascular Disease and Vascular Function in Pediatric Type 1 Diabetes - 23/09/16
Abstract |
Objective |
To evaluate the relationship between social determinants of health (SDH) and cardiovascular disease (CVD) risk factors as well as a measure of arterial stiffness in adolescents with type 1 diabetes (T1D).
Study design |
SDH were measured with the validated Ontario Marginalization Index, derived from deidentified postal code data and stratified by quintile (first = least deprived; fifth = most deprived). SDH dimensions included material deprivation; ethnic concentration; and measures of dependency and residential instability. Metabolic control (hemoglobin A1c), cardiovascular risk metrics, and pulse wave velocity, as a measure of arterial stiffness, were related to SDH. Data were evaluated from a cohort of Canadian adolescents within the Adolescent Diabetes Cardiorenal Intervention Trial, a T1D clinical trial
Results |
A total of 704 participants were evaluated, and significant differences in hemoglobin A1c were evident at the extremes of material deprivation (8.4% vs 9.1% for least vs most deprived, P < .01). CVD risk factors were analyzed in 199 participants, with the most deprived reporting significantly less exercise (P = .004) and increased rates of smoking (P = .008). Increased material deprivation was associated with fewer metrics of “ideal” cardiovascular health attained. Arterial stiffness, as measured by pulse wave velocity, was associated positively with age, body mass index z score, and material deprivation.
Conclusion |
Increased material deprivation was associated with poorer glycemic control. Modifiable, lifestyle-related risk factors for CVD and early arterial wall change are associated with SDH and represent a target for clinical intervention to reduce future CVD burden in adolescents with T1D.
Le texte complet de cet article est disponible en PDF.Keywords : cardiovascular risk, social determinants of health, type 1 diabetes, pediatrics
Abbreviations : ACR, AdDIT, BMI, CVD, HbA1c, ICH, ISPAD, LDL, ON-Marg, PWV, Q1, Q2, Q4, Q5, SDH, T1D
Plan
| Funded by the Juvenile Diabetes Research Foundation Canadian Clinical Trial Network, Diabetes UK, and the British Heart Foundation. The authors declare no conflicts of interest. |
Vol 177
P. 167-172 - octobre 2016 Retour au numéro
Article précédent
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