title: Social Determinants of Health Are Associated with Modifiable Risk Factors for Cardiovascular Disease and Vascular Function in Pediatric Type 1 Diabetes.
abstract: To evaluate the relationship between social determinants of health (SDH) and cardiovascular disease (CVD) risk factors as well as a measure of arterial stiffness in adolescents with type 1 diabetes (T1D).
  
  
  
  SDH were measured with the validated Ontario Marginalization Index, derived from deidentified postal code data and stratified by quintile (first  = least deprived; fifth = most deprived). SDH dimensions included material deprivation; ethnic concentration; and measures of dependency and residential instability. Metabolic control (hemoglobin A1c), cardiovascular risk metrics, and pulse wave velocity, as a measure of arterial stiffness, were related to SDH. Data were evaluated from a cohort of Canadian adolescents within the Adolescent Diabetes Cardiorenal Intervention Trial, a T1D clinical trial
  
  
  
  A total of 704 participants were evaluated, and significant differences in hemoglobin A1c were evident at the extremes of material deprivation (8.4% vs 9.1% for least vs most deprived, P < .01). CVD risk factors were analyzed in 199 participants, with the most deprived reporting significantly less exercise (P = .004) and increased rates of smoking (P = .008). Increased material deprivation was associated with fewer metrics of "ideal" cardiovascular health attained. Arterial stiffness, as measured by pulse wave velocity, was associated positively with age, body mass index z score, and material deprivation.
  
  
  
  Increased material deprivation was associated with poorer glycemic control. Modifiable, lifestyle-related risk factors for CVD and early arterial wall change are associated with SDH and represent a target for clinical intervention to reduce future CVD burden in adolescents with T1D.
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children & University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Inman
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children & University of Toronto, Toronto, Ontario, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Daneman
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children & University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Curtis
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children & University of Toronto, Toronto, Ontario, Canada.
authors.forename: Etienne
authors.initials: E
authors.lastname: Sochett
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children & University of Toronto, Toronto, Ontario, Canada.
authors.forename: Antoine
authors.initials: A
authors.lastname: Clarke
authors.affiliation: Department of Pediatrics, University of Cambridge, Cambridge, UK.
authors.forename: David B
authors.initials: DB
authors.lastname: Dunger
authors.affiliation: Institute of Child Health, University College London, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Deanfield
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children & University of Toronto, Toronto, Ontario, Canada. Electronic address: Farid.mahmud@sickkids.ca.
authors.forename: Farid H
authors.initials: FH
authors.lastname: Mahmud
mesh_terms: D000293:Adolescent; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000209:etiology*; D058065:Diabetic Cardiomyopathies / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D063177:Pulse Wave Analysis; D012307:Risk Factors; D064890:Social Determinants of Health; D059289:Vascular Stiffness
keywords: cardiovascular risk; pediatrics; social determinants of health; type 1 diabetes