Relationship Between Multiple Measures of Financial Hardship and Glycemic Control in Older Adults With Diabetes

Abstract

Aim: To examine the relationship between multiple measures of financial hardship and glycemic control in older adults with diabetes. Methods: Using data from Health and Retirement Study (HRS), we investigated four measures of financial hardship: difficulty paying bills, ongoing financial strain, decreasing food intake due to money, and taking less medication due to cost. Using linear regression models, we investigated the relationship between each measure, and a cumulative score of hardships per person, on glycemic control (HbA1c). Results: After adjustment, a significant relationship existed with each increasing number of hardships associated with increasing HbA1c (0.09, [95%CI 0.04, 0.14]). Difficulty paying bills (0.25, [95%CI 0.14, 0.35]) and decreased medication usage due to cost (0.17, [95%CI 0.03, 0.31]) remained significantly associated with HbA1c. Conclusion: In older adults, difficulty paying bills and cost-related medication nonadherence is associated with glycemic control, and every additional financial hardship was associated with an increased HbA1c by nearly 0.1%.

Propensity score weighted associations between financial strain and subsequent inflammatory biomarkers of aging among a representative sample of U.S. older adults

“…Financial strain predicted subsequent IL-6 and CRP levels using a propensity-score approach among a nationally representative sample of U.S. older adults. These results build on those from prior studies reviewed earlier linking financial strain with inflammatory biomarkers [ 20 – 22 ] by providing relatively stronger evidence of an underlying causal relationship. Together with results elsewhere linking inflammatory cytokines to disability, dementia, and mortality in older adults, these results suggest that inflammatory cytokines may account for the disparities in these outcomes based on financial strain exposure.…”

“…Notably, financial strain did not predict levels of CMV antibodies or hemoglobin A1c in adjusted analyses, despite evidence of an association with hemoglobin A1c found in another study [ 22 ] and evidence that older adults compromise basic necessities including food when experiencing financial challenges [ 30 , 31 , 41 ]. There are several potential reasons for this.…”

“…Studies conducted among a convenience sample [ 20 ], and a regional sample [ 21 ], have shown that financial strain is associated with higher levels of CRP and IL-6 [ 20 , 21 ]. Among a national sample of U.S. older adults, financial strain was associated with higher hemoglobin A1c [ 22 ]. Together, these cross-sectional studies show correlation, but longitudinal studies with stronger causal methods among nationally representative samples are needed to elucidate underlying mechanisms.…”

Hypertension, Diabetes and Medication Adherence among the Older Supplemental Nutritional Assistance Program Population

“…Cardio-metabolic diseases such as diabetes and hypertension are of particular concern among older adults who are food insecure. Not only are diabetes and hypertension more prevalent among low-income and food insecure individuals (Bhargava & Lee, 2017;Fryar et al, 2017aFryar et al, , 2017bJih et al, 2018), food insecure individuals living with diabetes and/or hypertension have poorer disease control, such as sub-optimal glycemic or blood pressure control (Bawadi et al, 2012;Walker et al, 2021;Wang et al, 2015). This may be because food insecure individuals living with diabetes and/or hypertension have poorer diet quality (Orr et al, 2019), but also because they have higher rates of cost-related medication non-adherence (Berkowitz et al, 2014;Gundersen & Ziliak, 2015), even after controlling for socio-demographic characteristics (Irving et al, 2014).…”

Social Care Recommendations in National Diabetes Treatment Guidelines

“…These rates have increased more rapidly in low-income and racialized populations—demonstrating pervasive health inequities [ 6 •, 7 ]. The observed racial and ethnic disparities stem in part from the intertwining of race and poverty in the USA: financial insecurity, lack of transportation access, and low levels of literacy disproportionately affect US people of color [ 6 •, 7 ], and these factors influence patients’ level of engagement in care [ 8 , 9 ]. A new wave of innovations is needed to confront the US T2D epidemic and the deeply entrenched social and economic inequities that have exacerbated it.…”