Socioeconomic Inequality in Metabolic Control Among Children With Type 1 Diabetes: A Nationwide Longitudinal Study of 4,079 Danish Children.

Abstract

To examine inequality in glycemic control by maternal educational level among children with type 1 diabetes in a setting with universal access to health care. This was a longitudinal nationwide study of 4,079 Danish children with type 1 diabetes between the years 2000 and 2013. Children were divided into four groups based on mothers' education prebirth (≤high school [<i>n</i> = 1,643], vocational or 2-year college [<i>n</i> = 1,548], bachelor's degree [<i>n</i> = 695], ≥master's degree [<i>n</i> = 193]). Means of socioeconomic and treatment characteristics were compared between groups. HbA_1c and the number of daily glucose tests were compared repeatedly from onset until 5 years after onset across groups. HbA_1c was compared across daily blood glucose testing frequency and groups. Linear regression was used to compare HbA_1c across groups with and without adjustment for socioeconomic and treatment characteristics. Large differences in HbA_1c across maternal education were found. The mean level of HbA_1c during follow-up was 59.7 mmol/mol (7.6%) for children of mothers with ≥master's degrees and 68.7 mmol/mol (8.4%) for children of mothers with ≤high school (difference: 9.0 mmol/mol [95% CI 7.5, 10.6]; 0.8% [95% CI 0.7, 1.0]). The associations were attenuated but remained significant after adjustment. Observable characteristics explained 41.2% of the difference in HbA_1c between children of mothers with ≤high school and mothers with ≥master's degree; 22.5% of the difference was explained by more frequent blood glucose monitoring among the children with the highly educated mothers. Family background is significantly related to outcomes for children with type 1 diabetes, even with universal access to health care.