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

AimsTo systematically review the evidence of socioeconomic inequalities for adults with type 1 diabetes in relation to mortality, morbidity and diabetes management.MethodsWe 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.ResultsA 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.ConclusionsLow 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.研究目的：系统梳理1型糖尿病（type 1 diabetes）成人患者社会经济不平等与死亡率、发病率及糖尿病管理相关的证据。 研究方法：本研究在6个相关数据库中开展系统性文献检索，纳入所有报道1型糖尿病成人患者社会经济指标与死亡率、发病率或糖尿病管理之间关联的研究。对所有纳入研究进行数据提取与质量评价，并采用叙述性综合法开展分析。 研究结果：本研究共检索到33项符合纳入标准的研究，其中12项为队列研究、19项为横断面研究、2项为病例对照研究。无论所处医疗保障体系如何，低社会经济地位均与较差的临床转归相关。在校正其他危险因素后，10项研究中有9项显示，社会经济地位是1型糖尿病成人患者死亡率的独立统计学显著预测因子，另有8项研究显示其为发病率的独立统计学显著预测因子。低社会经济地位与糖尿病管理的部分维度存在关联。尽管16项研究中仅3项对混杂因素及其他危险因素进行了校正，但在这3项研究中，糖尿病管理不佳均与较低的社会经济地位显著相关。 研究结论：即便在可获得全民医疗保障的人群中，低社会经济地位仍与1型糖尿病成人患者更高的死亡率和发病率相关。鉴于当前相关证据匮乏，且糖尿病管理或可缓解低社会经济地位带来的不良影响，低社会经济地位与糖尿病管理间的关联仍需开展进一步研究。