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Impact of parental socioeconomic status on excess mortality in subjects with childhood onset type-1 diabetes
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. (Gisela Dahlquist)
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aims/Hypothesis: The aim of this study was to analyze the possible impact of parental and individual socioeconomic status (SES) on all cause mortality in a population based cohort of childhood onset T1D.

Methods: Subjects recorded in the Swedish Childhood Diabetes Registry (SCDR) January 1 1978 to December 31 2008 were included (n=14 409). The SCDR was linked to the Swedish Cause of Death Register (CDR) and the Longitudinal Integration Database for Health Insurance and Labour Market Studies (LISA). SES measures (education and income support) wtypeere retrieved from the LISA for the years 1990-2010. Mortality data were retrieved from the CDR as of December 31, 2010.

Results: At a mean follow-up of 24.4 years (maximum 47.5), 238 deaths occurred in a total of 357 048 person-years at risk. In crude analyses, low maternal education predicted mortality for male cases only (p=0.046), while parental income support predicted mortality in both sexes (p<0.001 for both). In Cox models stratified by age at death groups and adjusted for age at onset and sex, parental income support predicted mortality among young adults ( ≥18 years of age) but not for children. Including the adult patient´s own SES in a Cox model showed that individual income support to the patient predicted mortality occurring at ≥ 24 years of age when adjusting for age at onset, sex and parental SES.

Conclusions/Interpretation: Low parental SES, mirrored by the need of income support, increases mortality risk in childhood onset type-1 diabetics who died after the age of 18 years.

Keyword [en]
Mortality, type-1 diabetes, socioeconomic status
National Category
Pediatrics
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-85246OAI: oai:DiVA.org:umu-85246DiVA: diva2:692445
Available from: 2014-01-31 Created: 2014-01-31 Last updated: 2014-01-31Bibliographically approved
In thesis
1. Epidemiological studies of childhood diabetes and important health complications to the disease
Open this publication in new window or tab >>Epidemiological studies of childhood diabetes and important health complications to the disease
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aims: The overall aim of this thesis was to increase knowledge regarding the occurrence of childhood onset T1D and T2D in Sweden and in relation to that describe and elucidate important aspects on two grave complications to diabetes; end-stage renal disease (ESRD) and mortality. The two first studies included in this thesis aimed to describe and analyze the cumulative incidence of childhood onset T1D in Sweden and to assess the occurrence of undetected T2D in Swedish children. The aim with the third study was to describe the cumulative incidence of ESRD, and to analyze how ESRD risk differs with age at-onset and sex. The aim of the fourth study was to show how parental socioeconomic status (SES) affects all cause mortality in Swedish patients with childhood onset T1D.

Study populations: The foundation for the studies on T1D was data from the Swedish Childhood Diabetes Registry (SCDR). When studying ESRD we also included adult onset T1D cases from the Diabetes Incidence Study in Sweden (DISS). The study on T2D was a population-based screening study where BMI was measured in 5528 school-children and hemoglobin A1c was measured in children with overweight according to international age and sex specific BMI cut-offs. To study ESRD and mortality, we linked the SCDR to various nationwide registers containing individual information on SES, mortality and ESRD.

Results: The incidence rates of childhood onset T1D has continued to increase in Sweden 1977–2007. Age- and sex-specific incidence rates varied from 21.6 (95% CI 19.4–23.9) during 1978–1980 to 43.9 (95% CI 40.7– 47.3) during 2005–2007. Cumulative incidence by birth-cohorts has shifted to a younger age at-onset over the first 22 years of incidence registration. From the year 2000 there was a significant reverse in this trend (p<0.01). In contrast to the increase of T1D, we found no evidence of undetected T2D among Swedish school children. Despite a relatively high incidence in T1D in Sweden there is low cumulative incidence of ESRD, 3.3% at maximum 30 years of duration. We found difference between the sexes regarding long-term risk of developing ESRD that was dependent on the age at onset of T1D. When analyzing how socioeconomic status affects mortality in different age at death groups, we found that having parents that received income support increased mortality up to three times in those who died after 18 years of age.

Conclusion: The incidence of childhood onset T1D continued to increase in Sweden 1978-2007. Between the years 1978-1999 there was a shift to a younger age at-onset, but from the year 2000 there is a change in this shift indicating a possible trend break. The prevalence of T2D among Swedish children up to 12 years of age is probably very low. There is still a low cumulative incidence of T1D associated ESRD in Sweden. The risk of developing ESRD depends on age at-onset of T1D, and there is a clear difference in risk between men and woman. Excess mortality among subjects with childhood onset T1D still exists, and low parental socioeconomic status additionally increased mortality in this group.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. 45 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1625
Keyword
Type- 1 diabetes, type-2 diabetes, end stage renal disease, mortality, socioeconomic status
National Category
Public Health, Global Health, Social Medicine and Epidemiology Endocrinology and Diabetes Pediatrics
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-85248 (URN)978-91-7459-804-9 (ISBN)
Public defence
2014-02-21, Stora Aulan, Sunderby sjukhus, Sunderby sjukhus, Luleå, 13:00 (Swedish)
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Supervisors
Available from: 2014-01-31 Created: 2014-01-31 Last updated: 2014-01-31Bibliographically approved

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