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Marginal structural model to evaluate the joint effect of socioeconomic exposures on the risk of developing end-stage renal disease in patients with type 1 diabetes: A longitudinal study based on data from the Swedish Childhood Diabetes Study Group
University of Perugia, . Department of Economics, Division of Statistics,.
Umeå University, Faculty of Medicine, Department of Clinical Sciences.
Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
2017 (English)In: Annals of Epidemiology, ISSN 1047-2797, E-ISSN 1873-2585Article in journal (Refereed) Published
Abstract [en]

Purpose: Diabetic nephropathy is a severe complication of type 1 diabetes (T1D) that may lead to renal failure and end-stage renal disease (ESRD) demanding dialysis and transplantation. The aetiology of diabetic nephropathy is multifactorial and both genes and environmental and life style related factors are involved. In this study we investigate the effect of the socioeconomic exposures unemployment and receiving income support on the development of ESRD in T1D patients, using a marginal structural model in comparison with standard logistic regression models.

Methods: The study is based on the Swedish Childhood Diabetes Register which in 1977 started to register patients developing T1D before 15 years of age. In the analyses we include patients born between 1965 and 1979, developing diabetes between 1977 and 1994, followed until 2013 (n=4034). A marginal structural model (MSM) was fitted to adjust for both baseline and time-varying confounders.

Results: The main results of the analysis indicate that being unemployed for more than one year and receiving income support are risk factors for the development of ESRD. Multiple exposure over time to these risk factors increases the risk associated with the disease.

Conclusions: Using a MSM is an advanced method well suited to investigate the effect of exposures on the risk of complications of a chronic disease with longitudinal data. The results show that socioeconomic disadvantage increases the risk of developing ESRD in patients with type 1 diabetes.

Place, publisher, year, edition, pages
2017.
Keyword [en]
Socioeconomic disparities, Type 1 diabetes, end stage renal disease, marginal structural model
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-138138DOI: dx10.1016/j.annepidem.2017.07.003OAI: oai:DiVA.org:umu-138138DiVA: diva2:1131289
Funder
The Royal Swedish Academy of SciencesSwedish Research Council, project number 0753
Available from: 2017-08-14 Created: 2017-08-14 Last updated: 2017-08-30

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CiteExportLink to record
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Cite
Citation style
  • apa
  • ieee
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  • Other style
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Language
  • de-DE
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  • nn-NB
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Output format
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