Socioeconomic inequalities in mortality, morbidity and diabetes management for adults with type 1 diabetes: A systematic review

To systematically review the evidence of socioeconomic inequalities for adults with type 1 diabetes in relation to mortality, morbidity and diabetes management. We carried out a systematic search across six relevant databases and included all studies reporting associations between socioeconomic indi...

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Bibliographic Details
Published in:PloS one Vol. 12; no. 5; p. e0177210
Main Authors: Scott, Anne, Chambers, Duncan, Goyder, Elizabeth, O’Cathain, Alicia
Format: Journal Article
Language:English
Published: United States Public Library of Science 10.05.2017
Public Library of Science (PLoS)
Subjects:
Access control
Adult
Adults
Age
Analysis
Biology and Life Sciences
Cardiovascular diseases
Care and treatment
Chambers
Chronic conditions
Colleges & universities
Deprivation
Destruction
Diabetes
Diabetes mellitus
Diabetes Mellitus, Type 1 - epidemiology
Diabetes Mellitus, Type 1 - mortality
Diabetes Mellitus, Type 1 - therapy
Diagnosis
Disease Management
Economic factors
Environmental factors
Environmental monitoring
Format
Glucose
Health care
Health risks
Health Services Accessibility
Hemoglobin
Humans
Hypoglycemia
Insulin
Life span
Lists
Literature reviews
Management
Markers
Medicine and Health Sciences
Metabolism
Morbidity
Mortality
Patient outcomes
People and Places
Population studies
Populations
Research and Analysis Methods
Risk Factors
Searching
Social Class
Social interactions
Social Sciences
Socioeconomic Factors
Socioeconomics
Studies
Type 1 diabetes
United Kingdom
United Kingdom
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Description
Summary:To systematically review the evidence of socioeconomic inequalities for adults with type 1 diabetes in relation to mortality, morbidity and diabetes management. We carried out a systematic search across six relevant databases and included all studies reporting associations between socioeconomic indicators and mortality, morbidity, or diabetes management for adults with type 1 diabetes. Data extraction and quality assessment was undertaken for all included studies. A narrative synthesis was conducted. A total of 33 studies were identified. Twelve cohort, 19 cross sectional and 2 case control studies met the inclusion criteria. Regardless of healthcare system, low socioeconomic status was associated with poorer outcomes. Following adjustments for other risk factors, socioeconomic status was a statistically significant independent predictor of mortality in 9/10 studies and morbidity in 8/10 studies for adults with type 1 diabetes. There appeared to be an association between low socioeconomic status and some aspects of diabetes management. Although only 3 of 16 studies made adjustments for confounders and other risk factors, poor diabetes management was associated with lower socioeconomic status in 3/3 of these studies. Low socioeconomic status is associated with higher levels of mortality and morbidity for adults with type 1 diabetes even amongst those with access to a universal healthcare system. The association between low socioeconomic status and diabetes management requires further research given the paucity of evidence and the potential for diabetes management to mitigate the adverse effects of low socioeconomic status.
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Conceptualization: AS AOC EG.Formal analysis: AS DC.Investigation: AS DC.Methodology: AS DC AOC EG.Validation: DC.Writing – original draft: AS DC.Writing – review & editing: AS DC AOC EG.
Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0177210