The Longitudinal Influence of Social Determinants of Health on Glycemic Control in Elderly Adults With Diabetes

Abstract

This study aimed to understand the longitudinal relationship between financial, psychosocial, and neighborhood social determinants and glycemic control (HbA 1c ) in older adults with diabetes. RESEARCH DESIGN AND METHODSData from 2,662 individuals with self-reported diabetes who participated in the Health and Retirement Study (HRS) were used. Participants were followed from 2006 through 2014. Financial hardship, psychosocial, and neighborhood-level social determinant factors were based on validated surveys from the biennial core interview and RAND data sets. All social determinant factors and measurements of HbA 1c from the time period were used and treated as time varying in analyses. SAS PROC GLIMMIX was used to fit a series of hierarchical linear mixed models. Models controlled for nonindependence among the repeated observations using a random intercept and treating each individual participant as a random factor. Survey methods were used to apply HRS weighting. RESULTSBefore adjustment for demographics, difficulty paying bills (b 5 0.18 [95% CI 0.02, 0.24]) and medication cost nonadherence (0.15 [0.01, 0.29]) were independently associated with increasing HbA 1c over time, and social cohesion (20.05 [20.10, 20.001]) was independently associated with decreasing HbA 1c over time. After adjusting for both demographics and comorbidity count, difficulty paying bills (0.13 [0.03, 0.24]) and religiosity (0.04 [0.001, 0.08]) were independently associated with increasing HbA 1c over time. CONCLUSIONSUsing a longitudinal cohort of older adults with diabetes, this study found that financial hardship factors, such as difficulty paying bills, were more consistently associated with worsening glycemic control over time than psychosocial and neighborhood factors.

Prevalence trends of diabetes subgroups in US: A data-driven analysis spanning three decades from NHANES (1988-2018)

“…Overall, we observed that sex, ethnicity, education, and age all significantly impacted the increasing prevalence of diabetes subgroups, indicating that the contribution of socioeconomic factors, obesity, and population aging is partly responsible for the overall increase in diabetes prevalence heterogeneity. Interestingly, we also observed that men had sharper increases in diabetes prevalence, particularly for SIID, which could be attributed to sex-based differences in treatment adherence and glycemic control (8). Notably, we observed that MOD and MARD prevalence consistently increased across most ethnic and age groups in both sexes, indicating that milder phenotypes had the largest increase over time.…”

The relationship between financial hardship and incident diabetic kidney disease in older US adults – a longitudinal study

“…A standard measure for change in financial hardship experience that captures duration of experience is necessary for further investigation. Meanwhile, glycemic control is established as a major determinant of DKD and existing studies show that material insecurities such as food insecurity and cost-related medication are adversely associated with diabetes control [ 28 ]. Evidence also suggests that cumulative exposure to economic hardship across adult life is associated with elevated inflammatory markers [ 27 ], which are associated with prevalent and incident chronic kidney disease [ 32 , 33 ].…”

“…Prior research studies have examined the relationship between financial hardship and health outcomes in individuals with diabetes [ 28 , 29 ]. However, studies investigating the association of financial hardship and complications of diabetes are sparse.…”

Toward Understanding Social Needs Among Primary Care Patients With Uncontrolled Diabetes

“… 12 - 14 A recent study in a rural population of mostly white patients demonstrated several social needs, including difficulties paying bills, rationing medication due to cost, race, food insecurity, and loneliness were associated with poor glycemic control over time. 15 Maintaining a healthy diet, physical activity, and having a healthy body mass index (BMI) can be challenging for individuals facing multiple social needs. 16 , 17 In prior work, patients experiencing more social needs were more likely to miss follow-up appointments.…”

“… 10 However, health systems, are not typically equipped to identify nor to address social needs of patients seen in the clinical setting. As a result, few studies 15 , 20 - 22 have examined the association of unmet social needs and diabetes control among predominantly Black and Latino patients seen in primary care and servicing predominantly low-income areas.…”