Assessing the impact of social determinants of health on diabetes severity and management

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Abstract

Objective: Adverse Social Determinants of Health (SDoH) are considered major obstacles to effective management of type-2 diabetes. This study aims to quantify the impact of SDoH factors on diabetes management outcomes. Materials and Methods: We quantified the joint impact of multiple SDoH by applying a self-control case series method—which accounts for confounding by using individuals as their own control—to electronic health record data from an academic health system in Maryland. Results: We found a consistent increase in HbA1c levels associated with SDoH across alternative study designs. The estimated total contributions of SDoH ranged 0.014–0.065 across the alternative designs. Transportation issues demonstrated particularly significant contributions, with estimates of 0.077–0.144. When assuming SDoH’s risk window to be ±45 days, for example, the total contribution was estimated to be 0.065 (95% CI [0.010, 0.120]) increase in HbA1c and the transportation issues’ contribution 0.134 (95% CI [0.020, 0.249]). Discussion and Conclusion: Our result suggests that reducing transportation barriers may be an effective SDoH intervention strategy for diabetes management; however, the clinical impact of such interventions warrants further investigation.

Original languageEnglish (US)
Article numberooae107
JournalJAMIA Open
Volume7
Issue number4
DOIs
StatePublished - Dec 1 2024

Keywords

  • HbA1c
  • self-controlled study design
  • social determinants of health
  • type 2 diabetes mellitus

ASJC Scopus subject areas

  • Health Informatics

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