For several decades, research in the field of health sociology as well as reports from the Canadian Public Health Association and the Institut national de la santé publique du Québec has shown that socioeconomic status (e.g., as defined by the level of income or education) is one of the most important factors influencing people’s health. This factor must be considered to better understand the daily lives of people with type 1 diabetes (T1D) and the associated risks of complications.
Studies have shown a connection between a high risk of diabetes-related complications and low socioeconomic status. However, most of these studies were conducted with people living with type 2 diabetes (T2D) or other chronic illnesses, and/or in areas where there are no government insurance plans (e.g., RAMQ in Quebec, AHCIP in Alberta).
Using BETTER registry data
A recent study based on BETTER registry data showed a connection between the risk of T1D-related complications and socioeconomic status. This study is one of the few to observe the impact of this factor in a context of public and universal health insurance plans. The research was conducted using responses from 1,333 registry participants.
Factors such as family income, level of education, employment status, type of health insurance (private, public, hybrid), and the Material and Social Deprivation Index (MSDI), which provides information based on postal code, were used to define socioeconomic status.
When low socioeconomic status means a higher risk of complications
The study shows that the lower the socioeconomic status (income, education, material and social disadvantage based on postal code), the higher the blood sugar levels and the risk of both short-term (e.g., severe hypoglycemia, ketoacidosis) and long-term complications (e.g., retinopathy, neuropathy, cardiovascular disease, depression). This finding was consistent regardless of the time since diagnosis, gender, and type of treatment (injections or insulin pump). Adults with T1D and lower socioeconomic status therefore have a harder time managing their diabetes on a daily basis and are at greater risk of complications.
Public insurance plans don’t prevent inequities
This finding highlights the enduring inequities that exist despite the implementation of a public insurance plan that should provide equal access to care (e.g., treatments, drugs, technologies) for the entire population while reducing the economic burden on individuals. Social and economic inequalities are therefore still present and are a barrier to achieving glycemic targets. There are also other sociocultural factors to consider that may influence people’s relationship with their health and, therefore, their experience with diabetes management.
It’s essential to implement measures to reduce these inequalities in order to improve the lives of people with T1D. Further research will be needed to understand why a lower socioeconomic status increases the risk of complications and to develop strategies to reduce inequities in the management of T1D.
The relationship between socioeconomic status and health behaviours such as diet or physical activity should be looked into further.
To better understand these connections and answer these questions, it’s important that people with T1D from disadvantaged backgrounds take the time to sign up for the BETTER registry to describe their situation and express their needs. This research and access to reliable data will help educate policy makers about the day-to-day realities of living with T1D in order to develop information and resource allocation policies to address health inequities.
References :
- Ke C, Kim SJ, Shah BR, et al. Impact of Socioeconomic Status on Incidence of End-Stage Renal Disease and Mortality After Dialysis in Adults With Diabetes. Can J Diabetes. 2019;43(7):483-489.e4. doi:10.1016/j.jcjd.2019.04.006
- Talbo, M. K., Katz, A., Dostie, M., Legault, L., & Brazeau, A.-S. (2022). Associations between socioeconomic status and patient experience with type 1 diabetes management and complications: cross-sectional analysis of a cohort from Québec, Canada. Canadian Journal of Diabetes, 46(6), 569–577. https://doi.org/10.1016/j.jcjd.2022.02.008
- Yaghoubi, M., Mansell, K., Vatanparast, H., Steeves, M., Zeng, W., & Farag, M. (2020). Prevalence of type 1 and type 2 diabetes-related complications and their association with determinants identified in Canada’s survey on living with chronic diseases-diabetes component. Canadian Journal of Diabetes, 44(4), 304–311. https://doi.org/10.1016/j.jcjd.2019.09.001
Written by: Michel Dostie, patient partners of the BETTER project et Meryem Talbo, Dt.P., M. Sc.
Reviewed by: Sarah Haag, RN. BSc.
Linguistic revision by: Marie-Christine Payette
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