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Socioeconomic inequalities in mortality, morbidity and diabetes management for adults with type 1 diabetes: A systematic review

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  • Anne Scott
  • Duncan Chambers
  • Elizabeth Goyder
  • Alicia O’Cathain

Abstract

Aims: To systematically review the evidence of socioeconomic inequalities for adults with type 1 diabetes in relation to mortality, morbidity and diabetes management. Methods: We carried out a systematic search across six relevant databases and included all studies reporting associations between socioeconomic indicators and mortality, morbidity, or diabetes management for adults with type 1 diabetes. Data extraction and quality assessment was undertaken for all included studies. A narrative synthesis was conducted. Results: A total of 33 studies were identified. Twelve cohort, 19 cross sectional and 2 case control studies met the inclusion criteria. Regardless of healthcare system, low socioeconomic status was associated with poorer outcomes. Following adjustments for other risk factors, socioeconomic status was a statistically significant independent predictor of mortality in 9/10 studies and morbidity in 8/10 studies for adults with type 1 diabetes. There appeared to be an association between low socioeconomic status and some aspects of diabetes management. Although only 3 of 16 studies made adjustments for confounders and other risk factors, poor diabetes management was associated with lower socioeconomic status in 3/3 of these studies. Conclusions: Low socioeconomic status is associated with higher levels of mortality and morbidity for adults with type 1 diabetes even amongst those with access to a universal healthcare system. The association between low socioeconomic status and diabetes management requires further research given the paucity of evidence and the potential for diabetes management to mitigate the adverse effects of low socioeconomic status.

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  • Anne Scott & Duncan Chambers & Elizabeth Goyder & Alicia O’Cathain, 2017. "Socioeconomic inequalities in mortality, morbidity and diabetes management for adults with type 1 diabetes: A systematic review," PLOS ONE, Public Library of Science, vol. 12(5), pages 1-19, May.
    • Handle: RePEc:plo:pone00:0177210
    DOI: 10.1371/journal.pone.0177210
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    References listed on IDEAS

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    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    2. Mackenbach, Johan P., 2012. "The persistence of health inequalities in modern welfare states: The explanation of a paradox," Social Science & Medicine, Elsevier, vol. 75(4), pages 761-769.
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    1. Monica Webb Hooper & Charlene Mitchell & Vanessa J. Marshall & Chesley Cheatham & Kristina Austin & Kimberly Sanders & Smitha Krishnamurthi & Lena L. Grafton, 2019. "Understanding Multilevel Factors Related to Urban Community Trust in Healthcare and Research," IJERPH, MDPI, vol. 16(18), pages 1-16, September.
    2. Mario Morales & Maia Ingram & Ramses Sepulveda & Thomas Nuño & Ada M. Wilkinson-Lee & Jill E. Guernsey De Zapien & Scott Carvajal, 2023. "Risk Factors Associated with Diabetes among Mexican-Origin Adults in Southern Arizona," IJERPH, MDPI, vol. 20(12), pages 1-11, June.
    3. Ong, Kanyin Liane & Stafford, Lauryn K. & McLaughlin, Susan A. & Boyko, Edward J. & Vollset, Stein Emil & Smith, Amanda E. & Dalton, Bronte E. & Duprey, Joe & Cruz, Jessica A. & Hagins, Hailey & Linds, 2023. "Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021," Open Access Publications from Kiel Institute for the World Economy 287733, Kiel Institute for the World Economy (IfW Kiel).
    4. Felipe De la Fuente & María Angélica Saldías & Camila Cubillos & Gabriela Mery & Daniela Carvajal & Martín Bowen & María Paz Bertoglia, 2020. "Green Space Exposure Association with Type 2 Diabetes Mellitus, Physical Activity, and Obesity: A Systematic Review," IJERPH, MDPI, vol. 18(1), pages 1-18, December.

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