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Owusu BA, Doku DT. Living with type 1 diabetes and schooling among young people in Ghana: a truism of health selection, inadequate support, or artefactual explanation of educational inequalities? BMC Public Health 2024; 24:1137. [PMID: 38654212 DOI: 10.1186/s12889-024-18590-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/14/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Type 1 diabetes mellitus (T1DM) is mostly diagnosed among young people. Despite the evidence that T1DM is disruptive, and affects individuals' health and cognitive ability, there is dearth of knowledge on the impact of T1DM on schooling in LMICs including Ghana. In this research, we explored the impact of T1DM on the schooling of young people living with the disease, and discussed the results within health selection, social support, and artefactual perspectives of inequality. METHODS Data were extracted from a qualitative project on T1DM lived experiences in southern Ghana. The study participants were young persons living with T1DM (n = 28) and their caregivers (n = 12). They were purposively recruited to participate in the study using maximum variation and snowball sampling techniques and interviewed in their support group centres, homes, or healthcare facilities using semi-structured interview guides. A computer-assisted qualitative data analysis was performed using QSR NVivo 14 software, and the results were categorised into themes. RESULTS Three themes were identified from the transcripts. These themes were school and classroom attendance, choice of school, and school/academic performance. T1DM was a major reason for patients' limited contact hours with teachers, school drop-out, preference for day schools rather than boarding, opting for vocational training instead of continuation of formal education, limited concentration at school, and delayed educational progression. CONCLUSION T1DM impacted the schooling of young people living with the disease. The mechanisms of these impacts, and young peoples lived experiences are not artefactual, but rather support discourses on health selection and inadequate social support for young people living with the disease. The results call for the need to develop educational and social interventions to address these barriers. The full implementation of the Inclusive Education Policy (IEP) may contribute to reducing educational and social inequalities caused by ill-health.
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Affiliation(s)
| | - David Teye Doku
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Wetter-Wren SE, Himelhoch AC, Driscoll KA. A Systematic Review of the Effects of Provider Bias on Health in Youth and Young Adults with Type 1 Diabetes. Curr Diab Rep 2024; 24:45-60. [PMID: 38233705 DOI: 10.1007/s11892-023-01527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE OF REVIEW Although pervasive inequities in the health outcomes of youth and young adults with type 1 diabetes (T1D) exist, the role of provider bias in these inequities is not well-understood. The purpose of this review is to synthesize evidence from existing studies on the associations between patient characteristics, provider bias, and patient health. RECENT FINDINGS Fourteen articles were included. Determining the extent of the effects of provider bias on patient health is limited by a lack of consensus on its definition. Experiences of provider bias (e.g., shaming, criticism) negatively affects self-esteem, relationships with medical providers, and depressive symptoms. Provider bias also impacts diabetes technology recommendations, insulin regimen intensity, and risk for life-threatening T1D complications. Future studies are needed to develop questionnaires and interviews that better account for diverse experiences and interpretations of bias in T1D healthcare. More research is also needed to investigate mitigating factors to reduce provider bias as a way to improve psychological and physical health in individuals with T1D.
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Affiliation(s)
- Sara E Wetter-Wren
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Dr., Gainesville, FL, 32610, USA
| | - Alexandra C Himelhoch
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Dr., Gainesville, FL, 32610, USA
| | - Kimberly A Driscoll
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Dr., Gainesville, FL, 32610, USA.
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Ratnayake I, Pepper S, Anderson A, Alsup A, Mudaranthakam DP. An R Shiny Application (SDOH) for Predictive Modeling Using Regional Social Determinants of Health Survey Responses. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024; 54:21-27. [PMID: 37697462 PMCID: PMC10797831 DOI: 10.1177/27551938231201011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/06/2023] [Accepted: 08/01/2023] [Indexed: 09/13/2023]
Abstract
Social determinants of health (SDoH) surveys are data sets that provide useful health-related information about individuals and communities. This study aims to develop a user-friendly web application that allows clinicians to get a predictive insight into the social needs of their patients before their in-patient visits using SDoH survey data to provide an improved and personalized service. The study used a longitudinal survey that consisted of 108,563 patient responses to 12 questions. Questions were designed to have a binary outcome as the response and the patient's most recent responses for each of these questions were modeled independently by incorporating explanatory variables. Multiple classification and regression techniques were used, including logistic regression, Bayesian generalized linear model, extreme gradient boosting, gradient boosting, neural networks, and random forests. Based on the area under the curve values, gradient boosting models provided the highest precision values. Finally, the models were incorporated into an R Shiny application, enabling users to predict and compare the impact of SDoH on patients' lives. The tool is freely hosted online by the University of Kansas Medical Center's Department of Biostatistics and Data Science. The supporting materials for the application are publicly accessible on GitHub.
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Affiliation(s)
- Isuru Ratnayake
- Department of Biostatistics & Data Science, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Sam Pepper
- Department of Biostatistics & Data Science, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Aliyah Anderson
- Department of Biostatistics & Data Science, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Alexander Alsup
- PULM Pulmonary and Critical Care Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
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Tremblay ES, Bernique A, Garvey K, Astley CM. A Retrospective Cohort Study of Racial/Ethnic and Socioeconomic Disparities in Initiation and Meaningful Use of Continuous Glucose Monitoring among Youth With Type 1 Diabetes. J Diabetes Sci Technol 2023:19322968231183985. [PMID: 37394962 DOI: 10.1177/19322968231183985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
BACKGROUND Continuous glucose monitor (CGM) use improves type 1 diabetes (T1D) outcomes, yet children from diverse backgrounds and on public insurance have worse outcomes and lower CGM utilization. Using novel CGM data acquisition and analysis of two T1D cohorts, we test the hypothesis that T1D youth from different backgrounds experience disparities in meaningful CGM use following both T1D diagnosis and CGM uptake. METHODS Cohorts drawn from a pediatric T1D program were followed for one year beginning at diagnosis (n = 815, 2016-2020) or CGM uptake (n = 1392, 2015-2020). Using chart and CGM data, CGM start and meaningful use outcomes between racial/ethnic and insurance groups were compared using median days, one-year proportions, and survival analysis. RESULTS Publicly compared with privately insured were slower to start CGM (233, 151 days, P < .01), had fewer use-days in the year following uptake (232, 324, P < .001), and had faster first discontinuation rates (hazard ratio [HR] = 1.61, P < .001). Disparities were more pronounced among Hispanic and black compared with white subjects for CGM start time (312, 289, 149, P = .0013) and discontinuation rates (Hispanic HR = 2.17, P < .001; black HR = 1.45, P = .038), and remained even among privately insured (Hispanic/black HR = 1.44, P = .0286). CONCLUSIONS Given the impact of insurance and race/ethnicity on CGM initiation and use, it is imperative that we target interventions to support universal access and sustained CGM use to mitigate the potential impact of provider biases and systemic disadvantage and racism. By enabling more equitable and meaningful T1D technology use, such interventions will begin to alleviate outcome disparities between youth with T1D from different backgrounds.
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Affiliation(s)
- Elise Schlissel Tremblay
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Allison Bernique
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Katherine Garvey
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christina M Astley
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
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Davis SL, Jaser SS, Ivankova NV, Lemley T, Rice M. Using Mixed Methods Research in Children with Type 1 Diabetes: a Methodological Review. Curr Diab Rep 2023; 23:147-163. [PMID: 37097408 PMCID: PMC10651325 DOI: 10.1007/s11892-023-01509-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE OF REVIEW Many factors influence disease management and glycemic levels in children with type 1 diabetes (T1D). However, these concepts are hard to examine in children using only a qualitative or quantitative research paradigm. Mixed methods research (MMR) offers creative and unique ways to study complex research questions in children and their families. RECENT FINDINGS A focused, methodological literature review revealed 20 empirical mixed methods research (MMR) studies that included children with T1D and/or their parents/caregivers. These studies were examined and synthesized to elicit themes and trends in MMR. Main themes that emerged included disease management, evaluation of interventions, and support. There were multiple inconsistencies between studies when reporting MMR definitions, rationales, and design. Limited studies use MMR approaches to examine concepts related to children with T1D. Findings from future MMR studies, especially ones that use child-report, may illuminate ways to improve disease management and lead to better glycemic levels and health outcomes.
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Affiliation(s)
- Sara L. Davis
- Maternal Child Health Nursing, University of South Alabama, 5721 USA Dr N, Mobile, AL 36688, USA
| | - Sarah S. Jaser
- Division of Pediatric Endocrinology & Diabetes, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nataliya V. Ivankova
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Trey Lemley
- Biomedical Library, University of South Alabama, Mobile, AL, USA
| | - Marti Rice
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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Crossen SS, Wagner DV. Narrowing the Divide: The Role of Telehealth in Type 1 Diabetes Care for Marginalized Communities. J Diabetes Sci Technol 2023; 17:901-908. [PMID: 36896887 PMCID: PMC10348000 DOI: 10.1177/19322968231157367] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Widespread uptake of telehealth in response to the COVID-19 pandemic has highlighted geographic, demographic, and economic disparities in access to virtual care. However, research studies and clinical programs that predate the pandemic demonstrate the potential for telehealth-based interventions to improve access to and outcomes of type 1 diabetes (T1D) care for individuals in geographically or socially marginalized communities. In this expert commentary, we discuss telehealth-based care models that have been successful in improving care for marginalized T1D populations. We also outline the policy changes needed to expand access to such interventions to reduce established disparities in T1D care and promote better health equity among people living with T1D.
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Affiliation(s)
- Stephanie S. Crossen
- Division of Pediatric Endocrinology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - David V. Wagner
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
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Stern A, Duran B, Streisand R, Wang CH, Tully C, Clary L, Gallagher K, Cogen F, Karaviti L, Monaghan M, Hilliard ME. Parent Perspectives of School/Daycare Experiences in Young Children Newly Diagnosed With Diabetes. J Pediatr Psychol 2023; 48:490-501. [PMID: 36888882 PMCID: PMC10199729 DOI: 10.1093/jpepsy/jsad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVE A central part of family adjustment to a new diagnosis of type 1 diabetes (T1D) is integrating T1D management into the child's school/daycare. This may be particularly challenging for young children who rely on adults for their diabetes management. This study aimed to describe parent experiences with school/daycare during the first 1.5 years following a young child's T1D diagnosis. METHODS As part of a randomized controlled trial of a behavioral intervention, 157 parents of young children with new-onset (<2 months) T1D reported on their child's school/daycare experience at baseline and at 9- and 15-month post-randomization. We used a mixed-methods design to describe and contextualize parents' experiences with school/daycare. Qualitative data were collected via open-ended responses, and quantitative data were collected from a demographic/medical from. RESULTS While most children were enrolled in school/daycare at all time points, over 50% of parents endorsed that T1D affected their child's enrollment, rejection, or removal from school/daycare at 9 or 15 months. We generated five themes related to parents' school/daycare experiences: Child factors, Parent factors, School/Daycare factors, Cooperation between Parents and Staff, and Socio-historical factors. Parents of younger children and those with lower subjective socioeconomic status were significantly more likely to endorse challenges with school/daycare enrollment. CONCLUSIONS School/daycare settings present challenges for parents of young children with T1D. Changes may need to occur across contexts to support early childhood education, including advocacy resources for parents to navigate school policies, increased training for school staff, and healthcare team outreach initiatives to parents and schools.
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Affiliation(s)
- Alexa Stern
- Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, USA
| | - Brenda Duran
- Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, USA
| | - Randi Streisand
- Clinical and Translational Research, Children’s National Hospital, USA
- Department of Psychiatry, George Washington University School of Medicine, USA
| | - Christine H Wang
- Clinical and Translational Research, Children’s National Hospital, USA
| | - Carrie Tully
- Clinical and Translational Research, Children’s National Hospital, USA
- Department of Psychiatry, George Washington University School of Medicine, USA
| | - Lauren Clary
- Clinical and Translational Research, Children’s National Hospital, USA
- Department of Psychiatry, George Washington University School of Medicine, USA
| | - Katherine Gallagher
- Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, USA
| | - Fran Cogen
- Clinical and Translational Research, Children’s National Hospital, USA
- Department of Psychiatry, George Washington University School of Medicine, USA
| | - Lefkothea Karaviti
- Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, USA
| | - Maureen Monaghan
- Clinical and Translational Research, Children’s National Hospital, USA
- Department of Psychiatry, George Washington University School of Medicine, USA
| | - Marisa E Hilliard
- Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, USA
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Howe CJ, Morone J, Hawkes CP, Lipman TH. Racial Disparities in Technology Use in Children With Type 1 Diabetes: A Qualitative Content Analysis of Parents' Perspectives. Sci Diabetes Self Manag Care 2023; 49:55-64. [PMID: 36609201 DOI: 10.1177/26350106221145323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of the study was to describe differences in non-Hispanic Black (NHB) and non-Hispanic White (NHW) parents' perceptions of factors that influence the use of diabetes technology. METHODS Focus groups were conducted with parents of NHB and NHW children at a pediatric diabetes center in the Northeast United States. Kilbourne's health disparities framework informed the focus group guide and a priori coding for directed content analysis. Further analysis allowed subcategories to emerge inductively. RESULTS Twenty-one parents participated. Five subcategories emerged, describing differences in NHB and NHW parent decisions regarding diabetes technology: (1) child's choice, (2) shame versus pride, (3) pros and cons of technology, (4) time frame, and (5) blood glucose indications of readiness. NHB parents feared technology malfunction, worried that visible devices could worsen experienced stigma of diabetes diagnosis, and described the diabetes team as gatekeepers, who changed eligibility criteria for diabetes technology use for their research purposes. In contrast, NHW parents reported diabetes team expectation of diabetes technology use and did not report provider-related barriers. CONCLUSION This study adds to existing literature advancing our understanding of the patient and provider mechanisms underlying racial disparities in diabetes technology use. This understanding may guide development of interventions focused on patients, providers, and structural factors to improve equity in use of diabetes technology by youth with type 1 diabetes.
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Affiliation(s)
- Carol J Howe
- Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth, Texas
| | - Jennifer Morone
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Colin P Hawkes
- Diabetes Center for Children, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia
| | - Terri H Lipman
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia
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Knaus ME, Pendola G, Srinivas S, Wood RJ, Halaweish I. Social determinants of health and Hirschsprung-associated enterocolitis. J Pediatr Surg 2022:S0022-3468(22)00632-7. [PMID: 36371352 DOI: 10.1016/j.jpedsurg.2022.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Hirschsprung-associated enterocolitis (HAEC) is the most common cause of morbidity and mortality in patients with Hirschsprung disease (HD). The objective of this study was to examine the association of social determinants of health (SDOH) with HAEC. METHODS A review of patients who underwent primary pull through for HD at our institution from 2014 to 2021 was performed. Clinical, surgical, and SDOH data were collected. HAEC was defined by an international scoring system. Categorical variables were analyzed via Fisher's exact tests and continuous variables with Mood's median tests. RESULTS One hundred patients were identified with 29 patients (29%) having at least one episode of HAEC during a median follow-up of 31 months (IQR: 11.7-55.7). Children who utilized public transportation for clinic visits, had one or more missed appointments, had any reported safety concerns, were involved with Child Protective Services, had parents/guardians who were not married, lived with people other than their immediate family, or had mothers who reported drug use or lack of prenatal care were found to have a higher likelihood of developing HAEC (p<0.04 for all). Age at HD diagnosis, age at pull through, operative approach, length of aganglionic colon, and Trisomy 21 were not significant predictors of HAEC. CONCLUSIONS In our series of 100 patients undergoing primary pull through, there was a significant correlation of HAEC with several social determinants of health elements while anatomical and clinical factors were not associated with HAEC. Attention to social determinants of health and identifying high-risk patients may serve to prevent morbidity and mortality from HAEC. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Maria E Knaus
- Department of Pediatric Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Gabriella Pendola
- Department of Pediatric Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Shruthi Srinivas
- Department of Pediatric Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Richard J Wood
- Department of Pediatric Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Ihab Halaweish
- Department of Pediatric Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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Morone JF, Cronholm PF, Teitelman AM, Hawkes CP, Lipman TH. Underrepresented Voices: Impacts of Social Determinants of Health on Type 1 Diabetes Family Management in Single Parent Black Families. Can J Diabetes 2022; 46:602-610.e1. [DOI: 10.1016/j.jcjd.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/16/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
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Cuddapah GV, Vallivedu Chennakesavulu P, Pentapurthy P, Vallakati M, Kongara A, Reddivari P, Singareddy S, Chandupatla KP, Swamy M. Complications in Diabetes Mellitus: Social Determinants and Trends. Cureus 2022; 14:e24415. [PMID: 35619856 PMCID: PMC9126423 DOI: 10.7759/cureus.24415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 11/12/2022] Open
Abstract
Conditions that impact an individual's health are referred to as social determinants of health. Through a retrospective study (January 2017-February 2022) and statistical analysis, researchers looked at the relationship between social demands and type 2 diabetes mellitus (T2DM) diagnosis. All social demands, with the exception of childcare, were more typically documented in patients with T2DM. Prescription expense, conveyance, and health literacy were the domains with the greatest relationships. These results might help health systems and social service providers develop collaborations to help in certain areas.
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