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Mental health visits and low socio-economic status in adolescence are associated with complications of Type 1 diabetes in early adulthood: a population-based cohort study

Shulman R, Luo J, Shah BR. Diabet Med. 2018; Apr 2 [Epub ahead of print].

Aim — To determine the association of mental health visits and socio‐economic status in late adolescence with the risk of mortality and acute and chronic diabetes complications in early adulthood.

Methods — We conducted a population‐based cohort study of individuals in Ontario, Canada, who had their 20th birthday between January 1999 and March 2015 and a diagnosis of diabetes prior to their 15th birthday, using linked administrative databases (n=8491). The main outcome was death; other outcomes were hypoglycaemia or hyperglycaemia‐related hospitalizations and emergency department visits and chronic diabetes complications (dialysis, ophthalmological and macrovascular complications).

Results — There were 127 deaths, representing 59 361 person‐years. Low socio‐economic status and mental health visits were both associated with a higher risk of death [hazard ratio 2.03, (95% CI 1.13 to 3.64) and 2.45 (95% CI 1.71 to 3.51), respectively]. Those with the lowest socio‐economic status and a mental health visit had a higher rate of diabetes‐related hospitalizations (rate ratio 4.84, 95% CI 3.64 to 6.44) and emergency department visits (rate ratio 3.15, 95% CI 1.79 to 5.54). Low socio‐economic status and mental health visits were both associated with an increased risk of any chronic complication [hazard ratio 1.54 (CI 1.21 to 1.96) and 1.57 (CI 1.35 to 1.81), respectively].

Conclusion — We identified significant socio‐economic and mental health disparities in the risk of death and acute and chronic complications in early adulthood for people with childhood‐onset diabetes. Targeted interventions to prevent adverse events for these adolescents at highest risk should be evaluated.