(708) Social Determinants of Health Effects on Risk of Microalbuminuria Among Children With T1D

Tuesday, January 23, 2024

12:30 PM – 1:30 PM MT

Location: Connections Central - RST 10

First Author(s)

JH

Jia Xin Huang, MD (she/her/hers)

University of California San Francisco Medical Center
San Francisco, California

Co-Author(s)

TC

T. Charles Casper, PhD, MStat

Assistant Professor of Pediatrics
University of Utah School of Medicine, United States
CP

Casey E. Pitts, MD

Pediatric Emergency Medicine and Clinical Informatics fellow
Perelman School of Medicine at the University of Pennsylvania, United States
SM

Sage Myers, MD, MSCE

Associate Professor of Pediatrics
Perelman School of Medicine at the University of Pennsylvania, United States
RL

Rebecca Lynch, MD

Pediatric Resident
University of California, Davis, United States
LL

Lindsey Loomba-Albrecht, MD

Associate Clinical Professor of Pediatrics
University of California, Davis, United States
NK

Nathan Kuppermann, MD, MPH

Distinguished Professor of Emergency Medicine and Pediatrics
University of California, Davis, United States
EK

Elaine Ku, MD, MAS

Associate Professor of Pediatrics
University of California, San Francisco, United States
NG

Nicole Glaser, MD

Professor of Pediatrics
University of California, Davis, United States

Introduction: We recently demonstrated that acute kidney injury (AKI) during diabetic ketoacidosis (DKA) episodes in children with type 1 diabetes (T1D) is associated with development of microalbuminuria. Exploring whether social determinants of health (SDOH), in additional to clinical factors, contributes to the risk of developing microalbuminuria may facilitate the development of strategies to reduce this risk.

Methods: We performed a retrospective cohort study of children with T1D who had albuminuria levels obtained during routine care at 2 urban pediatric academic centers. SDOHs data (race, ethnicity, primary language, type of insurance, residential distance from clinic, and the child opportunity index (COI), a marker of neighborhood resources) were collected. COI is reported as very low, low, moderate, high, and very high. Cox proportional hazards regression models were used to identify SDOH variables associated with the risk of microalbuminuria.

Results: 2303 children were included (mean age at diagnosis 9.4 yr, mean duration 6.5 yr). Most had private insurance (68%), were of White race (72%), non-Hispanic ethnicity (91%), English-speaking (98%), and had high/very high COI (71.5%). The risk of microalbuminuria in univariable analysis was higher among children who were of Black race (HR1.40, 95%CI 0.92-2.13), Hispanic ethnicity (HR1.87, 95%CI 1.28-2.73), non-English speaking (HR3.05, 95%CI 1.69-5.47), very low COI (HR2.38, 95%CI 1.56-3.63). In multivariable models, age at diagnosis (aHR1.11, 95%CI 1.07,1.16), average HbA1c (aHR1.26, 95%CI1.14-1.40), number of DKA episodes with AKI (aHR1.42, 95%CI 1.17-1.72), non-English speaking (aHR2.60, 95%CI 1.40-4.84) were associated with increased HR for microalbuminuria, but COI was not. Private insurance (aHR0.69, 95%CI 0.49-0.98) and increased distance from clinic (aHR0.96, 95%CI 0.91-1.01) were associated with decreased risk.

Conclusions: Glycemic variables (HbA1c, DKA episodes with AKI) remain the main factors that identify risk of albuminuria among children with T1D who experienced AKI during DKA episodes. However, SDOH variables like non-English speaking, public insurance, and shorter travel distance also were associated with risk. Targeted efforts to reduce modifiable risk factors that can improve glycemic control and reduce DKA frequency for children at higher albuminuria risk are needed.