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Social Determinants of Health Are Associated with Markers of Renal Injury in Adolescents with Type 1 Diabetes.

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cam.issuedOnline2018-05-08
dc.contributor.authorCummings, Laura AM
dc.contributor.authorClarke, Antoine
dc.contributor.authorSochett, Etienne
dc.contributor.authorDaneman, Denis
dc.contributor.authorCherney, David Z
dc.contributor.authorReich, Heather N
dc.contributor.authorScholey, James W
dc.contributor.authorDunger, David B
dc.contributor.authorMahmud, Farid H
dc.contributor.orcidDunger, David [0000-0002-2566-9304]
dc.date.accessioned2018-09-21T15:22:21Z
dc.date.available2018-09-21T15:22:21Z
dc.date.issued2018-07
dc.description.abstractOBJECTIVE: To examine the relationship between the social determinants of health and markers of early renal injury in adolescent patients with type 1 diabetes (T1D). STUDY DESIGN: Renal outcomes included estimated glomerular filtration rate (eGFR) and albumin-creatinine excretion ratio (ACR). Differences in urinary and serum inflammatory markers also were assessed in relation to social determinants of health. Regression analysis was used to evaluate the association between the Ontario Marginalization Index (ON-Marg) as a measure of the social determinants of health, patient characteristics, ACR, eGFR, and renal filtration status (hyperfiltration vs normofiltration). RESULTS: Participants with T1D (n = 199) with a mean age of 14.4 ± 1.7 years and diabetes duration of 7.2 ± 3.1 years were studied. Mean eGFR was 122.0 ± 19.4 mL/min/1.73 m2. Increasing marginalization was positively associated with eGFR (P < .0001) but not with ACR (P = .605). Greater marginalization was associated with greater median levels of urinary interleukin (IL)-2, IL-12 (p40), macrophage-derived chemokine, monocyte chemoattractant protein-3, and tumor necrosis factor-β and serum IL-2. ON-Marg was significantly associated with eGFR after we controlled for age, sex, body mass index z score, ethnicity, serum glucose, and hemoglobin A1c in linear regression. A similar association between hyperfiltration and ON-Marg score was observed in multivariable logistic regression. CONCLUSION: Increasing marginalization is significantly associated with both eGFR and hyperfiltration in adolescents with T1D and is associated with significant changes in urinary inflammatory biomarkers. These findings highlight a potentially important interaction between social and biological determinants of health in adolescents with T1D.
dc.format.mediumPrint-Electronic
dc.identifier.doi10.17863/CAM.28013
dc.identifier.eissn1097-6833
dc.identifier.issn0022-3476
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/280647
dc.languageeng
dc.language.isoeng
dc.publisherElsevier BV
dc.publisher.urlhttp://dx.doi.org/10.1016/j.jpeds.2018.03.030
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectdiabetic kidney disease
dc.subjectsocial determinants
dc.subjecttype 1 diabetes
dc.subjectAcute Kidney Injury
dc.subjectAdolescent
dc.subjectBiomarkers
dc.subjectCreatinine
dc.subjectDiabetes Mellitus, Type 1
dc.subjectFemale
dc.subjectGlomerular Filtration Rate
dc.subjectHumans
dc.subjectInflammation Mediators
dc.subjectLogistic Models
dc.subjectMale
dc.subjectSerum Albumin, Human
dc.subjectSocial Determinants of Health
dc.subjectSocial Marginalization
dc.titleSocial Determinants of Health Are Associated with Markers of Renal Injury in Adolescents with Type 1 Diabetes.
dc.typeArticle
dcterms.dateAccepted2018-03-14
prism.endingPage253.e1
prism.publicationDate2018
prism.publicationNameJ Pediatr
prism.startingPage247
prism.volume198
rioxxterms.licenseref.startdate2018-07
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.typeJournal Article/Review
rioxxterms.versionVoR
rioxxterms.versionofrecord10.1016/j.jpeds.2018.03.030

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