Effects of family and neighborhood risks on glycemic control among young black adolescents with type 1 diabetes: Findings from a multi‐center study

Abstract

While individual and family risk factors that contribute to health disparities in children with type 1 diabetes have been identified, studies on the effects of neighborhood risk factors on glycemic control are limited, particularly in minority samples. This cross‐sectional study tested associations between family conflict, neighborhood adversity and glycemic outcomes (HbA1c) in a sample of urban, young Black adolescents with type 1 diabetes(mean age = 13.4 ± 1.7), as well as whether neighborhood adversity moderated the relationship between family conflict and HbA1c. Participants (N = 128) were recruited from five pediatric diabetes clinics in two major metropolitan US cities. Diabetes‐related family conflict was measured via self‐report questionnaire (Diabetes Family Conflict Scale; DFCS). Neighborhood adversity was calculated at the census block group level based on US census data. Indictors of adversity were used to calculate a neighborhood adversity index (NAI) for each participant. Median family income was $25,000, suggesting a low SES sample. In multiple regression analyses, DFCS and NAI both had significant, independent effects on glycemic control (β = 0.174, P = 0.034 and β = 0.226 P = 0.013, respectively) after controlling for child age, family socioeconomic status and insulin management regimen. Tests of effects of the NAI and DFCS interaction on HbA1c found no significant moderating effects of neighborhood adversity. Even within contexts of significant socioeconomic disadvantage, variability in degree of neighborhood adversity predicts diabetes‐related health outcomes in young Black adolescents with type 1 diabetes. Providers should assess social determinants of health such as neighborhood resources that may impact adolescents' ability to maintain optimal glycemic control.

Importance of caregivers' subjective social status and neighbourhood disadvantage for adolescents with type 1 diabetes

“…levels. 3,4 Residents of neighbourhoods experiencing multiple barriers to resources (access to healthcare, healthy food choices, safe spaces, etc.) often face increased exposure to stressors, 4,15 which may explain why adolescents from higher deprivation neighbourhoods are less likely to meet HbA 1c targets.…”

“…Findings from the current study indicate that neighbourhood disadvantage was significantly associated with glycaemic outcomes but not with diabetes management or diabetes distress among adolescents with type 1 diabetes. These findings are in line with previous literature demonstrating that adolescents from neighbourhoods with increased adversity and social inequality have higher HbA 1c levels 3,4 . Residents of neighbourhoods experiencing multiple barriers to resources (access to healthcare, healthy food choices, safe spaces, etc.)…”

“…In Step 1, race/ethnicity (β = −0.22) was a significant predictor. In step 2, ADI was African American/Black 47 [24] Asian 8 [4] American Indian or Alaska native 2 [1] Biracial 16 [8] Other/Declined to answer 2 [1] Child not a significant predictor (β = −0.09). In the final model, SSS was significantly associated with TIR (β = 0.26), explaining an additional 6% of the variance after adjusting for demographic factors and ADI (Table 3).…”

“…Adolescents from racial/ethnic minority and low-income populations experience disparities in diabetes treatment and outcomes, 1,2 and recent studies demonstrated that neighbourhood-level adversity predicts higher haemoglobin A 1c (HbA 1c ), further explaining the health disparities in adolescents with type 1 diabetes (T1D). 3,4 Subjective social status (SSS), or perceived position compared to others, is an established predictor of both morbidity and mortality in adults, and may explain outcomes beyond objective socioeconomic status (SES) measures (e.g., income, education and occupation) that are closely tied with neighbourhood factors and social determinants of health. 5,6 While current literature indicates a marked effect of SES on adolescent diabetes outcomes (e.g., HbA 1c , self management, diabetesrelated quality of life), 7 few studies have examined the effect of caregiver SSS or neighbourhood-level factors in relation to diabetes outcomes in adolescents with T1D.…”

Technology and health inequities in diabetes care: How do we widen access to underserved populations and utilize technology to improve outcomes for all?

“…At present, underserved people with T1D are less likely to use technologies such as continuous glucose monitoring (CGM) and insulin pump therapy 44,45 . There are numerous contributors to the digital divide in T1D, 46–54 as illustrated in Figure 3.…”