Large socioeconomic gap in period life expectancy and life years spent with complications of diabetes in the Scottish population with type 1 diabetes, 2013–2018

Abstract

Background We report the first study to estimate the socioeconomic gap in period life expectancy (LE) and life years spent with and without complications in a national cohort of individuals with type 1 diabetes. Methods This retrospective cohort study used linked healthcare records from SCI-Diabetes, the population-based diabetes register of Scotland. We studied all individuals aged 50 and older with a diagnosis of type 1 diabetes who were alive and residing in Scotland on 1 January 2013 (N = 8591). We used the Scottish Index of Multiple Deprivation (SIMD) 2016 as an area-based measure of socioeconomic deprivation. For each individual, we constructed a history of transitions by capturing whether individuals developed retinopathy/maculopathy, cardiovascular disease, chronic kidney disease, and diabetic foot, or died throughout the study period, which lasted until 31 December 2018. Using parametric multistate survival models, we estimated total and state-specific LE at an attained age of 50. Results At age 50, remaining LE was 22.2 years (95% confidence interval (95% CI): 21.6 − 22.8) for males and 25.1 years (95% CI: 24.4 − 25.9) for females. Remaining LE at age 50 was around 8 years lower among the most deprived SIMD quintile when compared with the least deprived SIMD quintile: 18.7 years (95% CI: 17.5 − 19.9) vs. 26.3 years (95% CI: 24.5 − 28.1) among males, and 21.2 years (95% CI: 19.7 − 22.7) vs. 29.3 years (95% CI: 27.5 − 31.1) among females. The gap in life years spent without complications was around 5 years between the most and the least deprived SIMD quintile: 4.9 years (95% CI: 3.6 − 6.1) vs. 9.3 years (95% CI: 7.5 − 11.1) among males, and 5.3 years (95% CI: 3.7 − 6.9) vs. 10.3 years (95% CI: 8.3 − 12.3) among females. SIMD differences in transition rates decreased marginally when controlling for time-updated information on risk factors such as HbA1c, blood pressure, BMI, or smoking. Conclusions In addition to societal interventions, tailored support to reduce the impact of diabetes is needed for individuals from low socioeconomic backgrounds, including access to innovations in management of diabetes and the prevention of complications.

Social deprivation and diabetic kidney disease: A European view

“…Diabetes management and secondary prevention education needs to be tailored to suit individual needs and abilities and to fit with their sociodemographic characteristics 46 . Höhn et al 80 . suggest incorporating outreach programs tailored specifically for more deprived socioeconomic groups and those disengaged with care, as well as an equitable roll out and uptake of technology.…”

“…Höhn et al . 80 suggest incorporating outreach programs tailored specifically for more deprived socioeconomic groups and those disengaged with care, as well as an equitable roll out and uptake of technology.…”

Socio‐economic disparities in hospital care among Dutch patients with diabetes mellitus

“…9,[11][12][13][14] Targets for cardiometabolic risk factors are less often met, and life expectancy and years spent without complications are lower than in those living without diabetes. 15,16 In the Netherlands, most studies related to SES and diabetes focus on type 2 diabetes. It is known that people with diabetes more often have low SES than high SES.…”

“…Use of diabetes technology, such as continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM), is, apart from reimbursement policies, also influenced by SES‐related factors at all ages 9,11–14 . Targets for cardiometabolic risk factors are less often met, and life expectancy and years spent without complications are lower than in those living without diabetes 15,16 . In the Netherlands, most studies related to SES and diabetes focus on type 2 diabetes.…”

Study Protocol- The impact of social deprivation on development and progression of diabetic kidney disease

“…The objective of this study is to explore the association between area level social deprivation and diabetic kidney disease in a cohort of adults living with diabetes in Ireland. Area based deprivation indices are well established and widely used and facilitate gradients to be demonstrated at a population level (35–39). To our knowledge, this will be the first study in Ireland to look at the association between deprivation and rate of decline in renal function, using a composite, area level measure of deprivation.…”