Elsevier

Primary Care Diabetes

Volume 17, Issue 2, April 2023, Pages 168-174
Primary Care Diabetes

Are social determinants of health associated with the development of early complications among young adults with type 2 diabetes? A population based study using linked databases

https://doi.org/10.1016/j.pcd.2023.01.002Get rights and content
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open access

Highlights

  • Social disadvantage may be present in diabetes complications in young adults.

  • Young men with non-Western origin were more likely to develop a complication.

  • Income was not associated with diabetes complication development.

  • Young adults with uncontrolled HbA1c were more likely to develop a complication.

  • Proactive treatment should focus on HbA1c regulation in all at-risk populations.

Abstract

Aims

To quantify the impact of social determinants of health (SDOH) on top of medical determinants on the development of diabetes-related complications in young adults with type 2 diabetes.

Methods

In this observational population-based study, SDOH (income and origin) were linked to routine primary care data. Young adults (18–45 years) with incident type 2 diabetes between 2007 and 2013 were included. The main outcome, the development of the first micro- or macrovascular complication, was analyzed by multivariate Cox regression. Medical determinants included antidiabetic treatment, HbA1c in the year after diagnosis, body mass index, comorbidity and smoking.

Results

Of 761 young adults (median age: 39 years (IQR 33–42), men: 49%, Western origin: 36%, low income: 48%), 154 developed at least one complication (median follow-up 99 months (IQR 73–123)). Young men of non-Western origin were more likely to develop a complication (HR 1.98 (1.19–3.30)), as were young adults with HbA1c > 7% (>53 mmol/mol) (HR: 1.72 95% CI: 1.15–2.57). No associations were found with income. Being women was protective.

Conclusion

In this multi-ethnic population, non-Western origin was associated with the development of complications, but only in men. Low income was not associated with developing complications. The importance of adequate HbA1c regulation was re-emphasized by this study.

Keywords

Type 2 diabetes
Social determinants of health
Young adults
Diabetes complications
Routine care data

Cited by (0)

1

both authors equally contributed to the article

2

0000-0003-3277-4003

3

0000-0003-1074-6255