Abstract: Evaluation of Child Opportunity Index 2.0 as a Predictor for Hemoglobin A1c in Youth with Type 1 Diabetes
Hamp Henning1, Kelsey Panfil1, Brent Lockee1, David D. Williams1, Erin M. Tallon1, Anna R. Kahkoska2, Angelica Cristello Sarteau2, Craig Vandervelden1, Susana R. Patton 3, Mark A. Clements1
1Children’s Mercy Kansas City (Kansas City, MO), 2University of North Carolina at Chapel Hill (Chapel Hill, NC), 3Nemour's Children's Health, (Jacksonville, FL)
Background and Aims: Research suggests neighborhoods in proximity to quality social, economic, and educational resources are associated with improved health outcomes among youth, yet their relationship with hemoglobin A1c (HbA1c) remains unknown. We examined this relationship in youths with type 1 diabetes (T1D) using the Child Opportunity Index 2.0 (COI), a composite metric summarizing education, health and environment, and socioeconomic opportunity per census tract.
Methods: We analyzed electronic health record data from 1,152 youths receiving care from a pediatric diabetes clinic network in the Midwest USA (Dec. 2015 – Jul. 2023). HbA1c measures that occurred ≤6 months after diagnosis were excluded. Youths’ addresses were geocoded and assigned to census tracts, corresponding to COI z-scores standardized at the national level. We used a generalized linear model with a Gamma distribution to evaluate the association of COI with youths’ most recent HbA1c, adjusting for CGM (yes/no), insulin pump (yes/no), race, ethnicity, insurance type, and age.
Results: The cohort had a median age of 13.6(7.1 IQR) years, a mean HbA1c of 8.4%(2.2 SD), and was 52.9% male, 24.0% non-White, 61.2% commercial insurance, 59.0% pump, and 75.3% CGM users. Youths with higher COI had lower HbA1c than youths with lower COI (p < .0001). Also, CGM or pump users had lower HbA1c (CGM: p < .0001; pump: p < .01).
Conclusions: Living in neighborhoods with quality schools, parks and playgrounds, healthy food and air quality, and socioeconomic opportunity is associated with lower youth HbA1c. Research evaluating whether COI supports prediction of future HbA1c is needed.