Abstract
Purpose
To analyse the association of area-level deprivation (German Index of Multiple Deprivation, GIMD 2010) with health- and disease-related quality of life (QoL) and glycaemic control (HbA1c) jointly with individual-level socioeconomic status (SES) in young patients with preschool-onset type 1 diabetes.
Methods
A total of 425 male and 414 female patients aged 11–21 years from a Germany-wide population-based survey completed the generic KINDL-R, the DISABKIDS chronic-generic module (DCGM-12), and the DISABKIDS diabetes-specific module with impact and treatment scales (QoL indicators; range 0–100 with higher scores representing better QoL). To analyse the association of area-level deprivation and SES with QoL and HbA1c, multiple linear regression models were applied adjusting for sociodemographic and health-related variables.
Results
Mean QoL scores (SD) were 73.2 (12.2) for the KINDL-R, 76.1 (16.1) for the DCGM-12, 66.2 (19.9) for diabetes impact, and 56.4 (27.3) for diabetes treatment (DISABKIDS). Mean HbA1c was 8.3 (1.4)%. While both QoL outcomes and HbA1c level improved with increasing individual SES, no association was observed between area-level deprivation (GIMD 2010) and either outcome.
Conclusions
Compared with individual SES, area-level deprivation seems to be of minor importance for QoL and glycaemic control in young people with early-onset type 1 diabetes.
This is a preview of subscription content, log in via an institution to check access.
Data availability
Due to data protection and privacy issues, data are only available from the authors upon request.
References
World Health Organization (WHO). (1998). Health21. An introduction to the health for all policy framework for the WHO European Region (European Health for All Series; no. 5), Copenhagen. Retrieved January 31, 2018, from http://www.euro.who.int/__data/assets/pdf_file/0003/88590/EHFA5-E.pdf?ua=115.02.2017.
Bohn, B., Rosenbauer, J., Icks, A., Vogel, C., Beyer, P., Rütschle, H., et al. (2016). Regional disparities in diabetes care for pediatric patients with type 1 diabetes. A cross-sectional DPV multicenter analysis of 24,928 German children and cdolescents. Experimental and Clinical Endocrinology & Diabetes, 124, 111–119. https://doi.org/10.1055/s-0042-101159.
World Health Organization (WHO). (2013). Health 2020. A European policy framework and strategy for the 21st century. Copenhagen. Retrieved January 31, 2018, from http://www.euro.who.int/__data/assets/pdf_file/0011/199532/Health2020-Long.pdf?ua=115.03.2017.
Maier, W., Fairburn, J., & Mielck, A. (2012). Regionale Deprivation und Mortalität in Bayern. Entwicklung eines ‘Index Multipler Deprivation’ auf Gemeindeebene. Gesundheitswesen, 74, 416–425. https://doi.org/10.1055/s-0031-1280846.
Kuznetsov, L., Maier, W., Hunger, M., Meyer, M., & Mielck, A. (2012). Regional deprivation in Bavaria, Germany: Linking a new deprivation score with registry data for lung and colorectal cancer. International Journal of Public Health, 57(5), 827–835. https://doi.org/10.1007/s00038-012-0342-4.
Maier, W., Scheidt-Nave, C., Holle, R., Kroll, L. E., Lampert, T., Du, Y., et al. (2014). Area level deprivation is an independent determinant of prevalent type 2 diabetes and obesity at the national level in Germany. Results from the National Telephone Health Interview Surveys ‘German Health Update’ GEDA 2009 and 2010. PLoS ONE, 9(2), e89661. https://doi.org/10.1371/journal.pone.0089661.
Grintsova, O., Maier, W., & Mielck, A. (2014). Inequalities in health care among patients with type 2 diabetes by individual socio-economic status (SES) and regional deprivation: A systematic literature review. International Journal for Equity in Health, 13, 43. https://doi.org/10.1186/1475-9276-13-43.
Lindner, L. M. E., Rathmann, W., & Rosenbauer, J. (2018). Inequalities in glycaemic control, hypoglycaemia and diabetic ketoacidosis according to socio-economic status and area-level deprivation in Type 1 diabetes mellitus: A systematic review. Diabetic Medicine, 35(1), 12–32. https://doi.org/10.1111/dme.13519.
Stahl-Pehe, A., Straßburger, K., Castillo, K., Bächle, C., Holl, R. W., Lange, K., et al. (2014). Quality of life in intensively treated youths with early-onset type 1 diabetes: A population-based survey. Pediatric Diabetes, 15, 436–443. https://doi.org/10.1111/pedi.12096.
Galler, A., Lindau, M., Ernert, A., Thalemann, R., & Raile, K. (2011). Associations between media consumption habits, physical activity, socioeconomic status, and glycemic control in children, adolescents, and young adults with type 1 diabetes. Diabetes Care, 34(11), 2356–2359. https://doi.org/10.2337/dc11-0838.
Downie, E., Craig, M. E., Hing, S., Cusumano, J., Chan, A. K. F., & Donaghue, K. C. (2011). Continued reduction in the prevalence of retinopathy in adolescents with type 1 diabetes: Role of insulin therapy and glycemic control. Diabetes Care, 34(11), 2368–2373. https://doi.org/10.2337/dc11-0102.
Dabelea, D. (2009). The accelerating epidemic of childhood diabetes. The Lancet, 373(9680), 1999–2000. https://doi.org/10.1016/S0140-6736(09)60874-6.
Stahl, A., Straßburger, K., Lange, K., Bächle, C., Holl, R. W., Giani, G., et al. (2012). Health-related quality of life among German youths with early-onset and long-duration type 1 diabetes. Diabetes Care, 35(8), 1736–1742. https://doi.org/10.2337/dc11-2438.
Bullinger, M., Brütt, A. L., Erhart, M., & Ravens-Sieberer, U. (2008). Psychometric properties of the KINDL-R questionnaire: results of the BELLA study. European Child & Adolescent Psychiatry, 17(Suppl 1), 125–132. https://doi.org/10.1007/s00787-008-1014-z.
European DISABKIDS Group. (2006). The DISABKIDS questionnaires: Handbook. Lengerich: Pabst Science Publishers.
Ravens-Sieberer, U., & Bullinger, M. (2000). KINDL-R manual. Revised version. Retrieved January 31, 2018, from https://www.kindl.org/app/download/6152202784/KINDL_Manual_Deutsch.pdf?.
Maier, W. (2017). Indizes Multipler Deprivation zur Analyse regionaler Gesundheitsunterschiede in Deutschland: Erfahrungen aus Epidemiologie und Versorgungsforschung. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. https://doi.org/10.1007/s00103-017-2646-2.
Maier, W., Holle, R., Hunger, M., Peters, A., Meisinger, C., Greiser, K. H., et al. (2013). The impact of regional deprivation and individual socio-economic status on the prevalence of Type 2 diabetes in Germany. A pooled analysis of five population-based studies. Diabetic Medicine, 30(3), 86. https://doi.org/10.1111/dme.12062.
EUROSTAT. (2018). Reference and management of nomenclatures: Degree of urbanization. Retrieved March 7, 2018, from http://ec.europa.eu/eurostat/ramon/miscellaneous/index.cfm?TargetUrl=DSP_DEGURBA.
Ly, T. T., Maahs, D. M., Rewers, A., Dunger, D., Oduwole, A., & Jones, T. W. (2014). ISPAD clinical practice consensus guidelines-hypoglycemia: Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatric Diabetes, 15(Suppl. 20), 180–192.
Cookson, R., Asaria, M., Ali, S., Ferguson, B., Fleetcroft, R., Goddard, M., et al. (2016). Health equity indicators for the English NHS: A longitudinal whole-population study at the small-area level. Health services and delivery research, no. 4.26. Southampton: NIHR Journals Library.
Acknowledgements
We thank all our participants for completing the questionnaires and the diabetes care teams throughout Germany for forwarding the questionnaires to their patients. Furthermore, we thank our colleagues at the German Diabetes Center for their faithful support during data collection and entry.
Funding
The German Diabetes Center receives institutional funding from the German Federal Ministry of Health (BMG) and the Ministry of Science and Research of the State of North Rhine-Westphalia (MIWF NRW). The ‘Clinical Course of Type 1 Diabetes in Children, Adolescents and Young Adults with Disease Onset in Preschool Age’ study is a prospective study supported by grants (Grant Numbers: 01GI0802, 01GI1109A, 01GI0859, 01GI1106) from the German Competence Network for Diabetes mellitus and the German Center for Diabetes Research (DZD, Grant Number: 82DZD00201) [both funded by the German Federal Ministry of Education and Research (BMBF)]. The current project was especially supported by a grant from the German Center for Diabetes Research (DZD). The DPV initiative (assisting in forwarding the study documents to eligible patients) is supported by the European Foundation for the Study of Diabetes (EFSD) and the Dr. Bürger-Büsing Foundation, in addition to the German Center for Diabetes Research (DZD). The funders were not involved in the study design, the data collection, the data analyses, the manuscript preparation, nor in the decision to submit the article for publication.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest relevant to this article.
Ethical approval
The type 1 diabetes study was carried out in accordance with the ethical standards laid down in the Declaration of Helsinki. The study was approved by the ethical review board at Heinrich-Heine-University Düsseldorf.
Informed consent
All patients and, in the case of minors, additionally their legal guardians, gave their written informed consent to participate in the study.
Additional information
In cooperation with the German Paediatric Surveillance Unit (ESPED) and the DPV-Science initiative, supported by the German Competence Network Diabetes Mellitus and the German Center for Diabetes Research (DZD)
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Bächle, C., Peneva, A., Maier, W. et al. Association of individual and area-level socioeconomic conditions with quality of life and glycaemic control in 11- to 21-year-old adolescents with early-onset type 1 diabetes: a cross-sectional study. Qual Life Res 27, 3131–3136 (2018). https://doi.org/10.1007/s11136-018-1949-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11136-018-1949-6