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Ethnic Status and Type 1 Diabetes Management in Young Adulthood

Year: 2023

Presenter Name: Julia Martin

Objective: Young adulthood is often characterized as a “high-risk period” for young adults (YA) with T1D as they have higher HbA1c (a metric of glucose control across the last 3-4 months) and poorer self-management compared to other age groups. Disparities along racial/ethnic dimensions can further exacerbate the challenges in maintaining target HbA1c and self-management for YA. However, recent theoretical work argues that racial/ethnic differences could be due to differences in socioeconomic status differences among racial/ethnic groups (Mello & Wiebe, 2020). The present study represents a unique opportunity to examine racial/ethnic differences in HbA1c and self-management in YA while controlling for a number of measures of socioeconomic status (self-reported socioeconomic status, neighborhood disorder based on census code data). In addition, I will examine the differences and disparities that exist in insurance status (public, private, uninsured) and how these relate to HbA1c.
Methods: The data come from the READY (REgulating Adherence to Diabetes as Young Adults; Berg et al., 2019) longitudinal study of young adults with T1D recruited at two clinical sites, Utah and Texas. Two-hundred and forty-seven individuals were recruited in their final year of high school, lived with a parent and had no condition that would prohibit study completion. The present sample includes individuals who completed baseline measures and for whom census data were available. Due to changes in Census tracts or non-inclusion in the American Community Survey (ACS), neighborhood characteristic data were not available for 21 participants. The sample included 59.6% female, 15% Hispanic, 70% non-Hispanic White, 4% Black, 2% Asian, 3% other or multiple race, and age 17.8 (SD-.39 years). The distribution of ethnic/minority status is representative of the clinics as well as national samples, where T1D is more frequent among non-Hispanic Whites. HbA1c was indexed from HbA1c assay kits obtained from CoreMedical Laboratories. Socioeconomic status was measured with MacArthur’s subjective social status measure where YA indicated on a ladder where they stand relative to others in their community. YA home addresses were used to determine their census tract code using the percent of the population living in the area achieving less than a high school, education under 18 living in poverty, and unemployed. Self-management was measured with the Diabetes Behavior Rating Scale (DBRS) and Self-care Inventory. The primary analysis will involve two multiple regressions (one for HbA1c, one for self-management) with indicators of socioeconomic status entered on the first step and ethnic and minority indicators on the second step. A second set of analyses will explore through Chi-square whether there are ethnic and minority differences in insurance status.
Results: in process
Conclusions: Understanding the racial/ethnic differences in HbA1c and self-management while controlling for socioeconomic status will offer tremendous insight into potential policy implications. I will be able to offer accurate insight and recommendations from a public health perspective.
University / Institution: University of Utah
Type: Poster
Format: In Person
Presentation #C68
SESSION C (1:45-3:15PM)
Area of Research: Social Sciences
Faculty Mentor: Cynthia Berg