title: Contribution of income to self-management and health outcomes in pediatric type 1 diabetes.
abstract: Low income has been established as a risk factor for poorer outcomes in youth with type 1 diabetes; however, the effect of moderate income has not been studied. The purpose of this secondary analysis of baseline data from a multi-site study was to compare glycemic control, self-management, and psychosocial outcomes [depression, stress, and quality of life (QOL)] at different income levels in adolescents with type 1 diabetes. Youth (n = 320, mean age = 12.3 + 1.1, 55% female, 64% white, mean A1C = 8.3 ± 1.4) completed established self-management and psychosocial measures. A1C levels were collected from medical records. Caregivers reported annual family income, categorized as high (>$80K), moderate ($40-80K), or low (<$40K). Youth from high-income families had significantly lower A1C (mean = 7.9 ± 1.2) than those from the moderate-income group (8.6 ± 1.7, p < 0.001) or the low-income group (mean A1C = 8.6 ± 1.5, p = 0.003). Youth from the high-income group reported significantly better diabetes problem solving and more self-management goals than those from the moderate- or low-income groups (both p < 0.01). Youth from the high-income group also reported significantly fewer symptoms of depression, lower levels of perceived stress, and better QOL than those in the moderate or low-income groups (all p < 0.05). Multivariate linear regression models were used to test psychological and behavioral predictors of A1C and QOL. Parents' education status (p < 0.05) and self-management activities (p < 0.01) were significant predictors of hemoglobin A1c, while income (p < 0.01) and self-management activities (p < 0.05) were significant predictors of QOL.
authors.affiliation: School of Nursing, Yale University, West Haven, CT, USA.
authors.forename: Kaitlyn
authors.initials: K
authors.lastname: Rechenberg
authors.affiliation: School of Nursing, Yale University, West Haven, CT, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Whittemore
authors.affiliation: School of Nursing, Yale University, West Haven, CT, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Grey
authors.affiliation: School of Nursing, Yale University, West Haven, CT, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Jaser
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D063868:Patient Outcome Assessment; D011379:Prognosis; D011788:Quality of Life; D012648:Self Care / Q000191:economics* / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose
keywords: diabetes mellitus (type 1); income; juvenile-onset diabetes; pediatrics; psychosocial support systems