Psychosocial and socioeconomic risk factors for premature death in young people with type 1 diabetes.
OBJECTIVE
Mortality from acute diabetes-related events is greatly raised in young adults with type 1 diabetes. Psychosocial and socioeconomic risk factors are examined for deaths from acute events separately from deaths due to other causes.


METHODS
This study had a nested case-control design. The cases were patients from the Diabetes UK cohort who died before age 40 years. Deaths were categorized as acute events or chronic conditions related to diabetes. Where possible, two matched control subjects were selected for each case. Data relating to psychosocial and socioeconomic factors and variables related to diabetes complications were extracted from the case notes. Risks of death were estimated by calculation of odds ratios (ORs).


RESULTS
Case notes were obtained for 98 case and 137 control subjects. Fifty-one deaths were attributed to acute causes, 34 to chronic conditions related to diabetes, and the remaining 13 were unrelated to diabetes. Living alone (OR 4.4), past drug abuse (5.7), and previous psychiatric referral (4.6) were all significantly associated with death from acute events but not death from chronic conditions. There was no association between deaths from acute events and nephropathy, hypertension, neuropathy, or retinopathy, although all of these were associated with deaths from chronic conditions.


CONCLUSIONS
The results indicate that psychosocial factors are powerful risk factors for mortality from acute events in patients with type 1 diabetes, although not for mortality from chronic conditions. The data enable the identification of a high-risk group suitable for targeting with preventive measures to reduce acute event mortality.
Section of Epidemiology, Institute of Cancer Research, Cotswold Road, Sutton, Surrey SM2 5NG, UK. susan.laing@icr.ac.uk
Susan P
SP
Laing
Michael E
ME
Jones
Anthony J
AJ
Swerdlow
Andrew C
AC
Burden
Wendy
W
Gatling
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D016022:Case-Control Studies; D002423:Cause of Death; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000191:economics / Q000401:mortality* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D011584:Psychology; D012016:Reference Values; D012307:Risk Factors; D012907:Smoking; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders; D006113:United Kingdom / Q000453:epidemiology