Associations of community socioeconomic deprivation with care processes and HbA1c values at time of type 2 diabetes diagnosis in Pennsylvania

Society for Epidemiologic Research (SER) Annual Meeting, June 16-19, 2020, Virtual.

Annemarie G. Hirsch, Melissa N. Poulsen, Cara Nordberg, Joseph DeWalle,  Jonathan S. Pollak, Carla Mercado, Deborah B. Rolka, Karen Siegel, Brian S. Schwartz 

Development of type 2 diabetes (T2D) can span more than 10 years before diagnosis. Microvascular disease progresses during this time, leaving individuals diagnosed later vulnerable to T2D complications. Community socioeconomic deprivation (CSD) is a risk factor for poor T2D control and complications, however it is unknown whether CSD disparities are present at diagnosis or occur later in disease.  We conducted a retrospective cohort study of 15,888 individuals newly diagnosed with T2D to evaluate associations of CSD and care process and clinical measures at time of diagnosis. Participants were primary care patients of a Pennsylvania health system who had contact with the system at least 2 years before diagnosis. Process measures included presence/absence of glycated hemoglobin (HbA1c) and low density lipoprotein (LDL) laboratory testing in the electronic health record between 1 year prior to and 2 weeks after diagnosis; clinical measures were HbA1c (percentage of total hemoglobin) and LDL (mg/dL) values closest to diagnosis date. CSD was measured with U.S. Census indicators: proportion in poverty, unemployed, on public assistance, with less than high school education, and not in the labor force. We used logistic and linear regression to evaluate associations between CSD quartiles (Q) and process and clinical measures, respectively, adjusting for confounding variables. Analyses were stratified by community type (townships, boroughs, cities). Mean HbA1c values were 0.21% (95% CI: 0.01, 0.40) higher in the most (Q4) deprived versus the least (Q1) deprived townships at time of diagnosis. Residents of the most deprived townships (versus least deprived) were less likely to have been tested for HbA1c (OR: 0.84, 95% CI: 0.72, 0.98) and LDL (0.84, 95% 0.71, 0.98) in 1 year before and up to 2 weeks after diagnosis.  T2D care and HbA1c levels differed at time of diagnosis by CSD, indicating disparities at the time of diagnosis in townships, but not in other community types.