Faculty Collaboration Database

The Longitudinal Influence of Social Determinants of Health on Glycemic Control in Elderly Adults With Diabetes. Diabetes Care 2020 Apr;43(4):759-766

Date

02/08/2020

Pubmed ID

32029639

Pubmed Central ID

PMC7085811

DOI

10.2337/dc19-1586

Scopus ID

2-s2.0-85082146434 (requires institutional sign-in at Scopus site)   26 Citations

Abstract

OBJECTIVE: This study aimed to understand the longitudinal relationship between financial, psychosocial, and neighborhood social determinants and glycemic control (HbA_1c) in older adults with diabetes.

RESEARCH DESIGN AND METHODS: Data from 2,662 individuals with self-reported diabetes who participated in the Health and Retirement Study (HRS) were used. Participants were followed from 2006 through 2014. Financial hardship, psychosocial, and neighborhood-level social determinant factors were based on validated surveys from the biennial core interview and RAND data sets. All social determinant factors and measurements of HbA_1c from the time period were used and treated as time varying in analyses. SAS PROC GLIMMIX was used to fit a series of hierarchical linear mixed models. Models controlled for nonindependence among the repeated observations using a random intercept and treating each individual participant as a random factor. Survey methods were used to apply HRS weighting.

RESULTS: Before adjustment for demographics, difficulty paying bills (β = 0.18 [95% CI 0.02, 0.24]) and medication cost nonadherence (0.15 [0.01, 0.29]) were independently associated with increasing HbA_1c over time, and social cohesion (-0.05 [-0.10, -0.001]) was independently associated with decreasing HbA_1c over time. After adjusting for both demographics and comorbidity count, difficulty paying bills (0.13 [0.03, 0.24]) and religiosity (0.04 [0.001, 0.08]) were independently associated with increasing HbA_1c over time.

CONCLUSIONS: Using a longitudinal cohort of older adults with diabetes, this study found that financial hardship factors, such as difficulty paying bills, were more consistently associated with worsening glycemic control over time than psychosocial and neighborhood factors.

Author List

Walker RJ, Garacci E, Palatnik A, Ozieh MN, Egede LE

Authors

Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of Wisconsin
Mukoso Nwamaka Ozieh MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Anna Palatnik MD Associate Professor in the Obstetrics and Gynecology department at Medical College of Wisconsin
Rebekah Walker PhD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Age Factors
Aged
Aged, 80 and over
Cohort Studies
Comorbidity
Cross-Sectional Studies
Diabetes Mellitus
Female
Humans
Longitudinal Studies
Male
Medication Adherence
Middle Aged
Social Determinants of Health
Surveys and Questionnaires