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Social Determinants of Health Are Associated with Markers of Renal Injury in Adolescents with Type 1 Diabetes
OBJECTIVE: To examine the relationship between the social determinants of health and markers of early renal injury in adolescent patients with type 1 diabetes (T1D). STUDY DESIGN: Renal outcomes included estimated glomerular filtration rate (eGFR) and albumin–creatinine excretion ratio (ACR). Differ...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Mosby
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016557/ https://www.ncbi.nlm.nih.gov/pubmed/29752172 http://dx.doi.org/10.1016/j.jpeds.2018.03.030 |
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author | Cummings, Laura A.M. Clarke, Antoine Sochett, Etienne Daneman, Denis Cherney, David Z. Reich, Heather N. Scholey, James W. Dunger, David B. Mahmud, Farid H. |
author_facet | Cummings, Laura A.M. Clarke, Antoine Sochett, Etienne Daneman, Denis Cherney, David Z. Reich, Heather N. Scholey, James W. Dunger, David B. Mahmud, Farid H. |
author_sort | Cummings, Laura A.M. |
collection | PubMed |
description | OBJECTIVE: To examine the relationship between the social determinants of health and markers of early renal injury in adolescent patients with type 1 diabetes (T1D). STUDY DESIGN: Renal outcomes included estimated glomerular filtration rate (eGFR) and albumin–creatinine excretion ratio (ACR). Differences in urinary and serum inflammatory markers also were assessed in relation to social determinants of health. Regression analysis was used to evaluate the association between the Ontario Marginalization Index (ON-Marg) as a measure of the social determinants of health, patient characteristics, ACR, eGFR, and renal filtration status (hyperfiltration vs normofiltration). RESULTS: Participants with T1D (n = 199) with a mean age of 14.4 ± 1.7 years and diabetes duration of 7.2 ± 3.1 years were studied. Mean eGFR was 122.0 ± 19.4 mL/min/1.73 m(2). Increasing marginalization was positively associated with eGFR (P < .0001) but not with ACR (P = .605). Greater marginalization was associated with greater median levels of urinary interleukin (IL)-2, IL-12 (p40), macrophage-derived chemokine, monocyte chemoattractant protein-3, and tumor necrosis factor-β and serum IL-2. ON-Marg was significantly associated with eGFR after we controlled for age, sex, body mass index z score, ethnicity, serum glucose, and hemoglobin A1c in linear regression. A similar association between hyperfiltration and ON-Marg score was observed in multivariable logistic regression. CONCLUSION: Increasing marginalization is significantly associated with both eGFR and hyperfiltration in adolescents with T1D and is associated with significant changes in urinary inflammatory biomarkers. These findings highlight a potentially important interaction between social and biological determinants of health in adolescents with T1D. |
format | Online Article Text |
id | pubmed-6016557 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Mosby |
record_format | MEDLINE/PubMed |
spelling | pubmed-60165572018-07-01 Social Determinants of Health Are Associated with Markers of Renal Injury in Adolescents with Type 1 Diabetes Cummings, Laura A.M. Clarke, Antoine Sochett, Etienne Daneman, Denis Cherney, David Z. Reich, Heather N. Scholey, James W. Dunger, David B. Mahmud, Farid H. J Pediatr Article OBJECTIVE: To examine the relationship between the social determinants of health and markers of early renal injury in adolescent patients with type 1 diabetes (T1D). STUDY DESIGN: Renal outcomes included estimated glomerular filtration rate (eGFR) and albumin–creatinine excretion ratio (ACR). Differences in urinary and serum inflammatory markers also were assessed in relation to social determinants of health. Regression analysis was used to evaluate the association between the Ontario Marginalization Index (ON-Marg) as a measure of the social determinants of health, patient characteristics, ACR, eGFR, and renal filtration status (hyperfiltration vs normofiltration). RESULTS: Participants with T1D (n = 199) with a mean age of 14.4 ± 1.7 years and diabetes duration of 7.2 ± 3.1 years were studied. Mean eGFR was 122.0 ± 19.4 mL/min/1.73 m(2). Increasing marginalization was positively associated with eGFR (P < .0001) but not with ACR (P = .605). Greater marginalization was associated with greater median levels of urinary interleukin (IL)-2, IL-12 (p40), macrophage-derived chemokine, monocyte chemoattractant protein-3, and tumor necrosis factor-β and serum IL-2. ON-Marg was significantly associated with eGFR after we controlled for age, sex, body mass index z score, ethnicity, serum glucose, and hemoglobin A1c in linear regression. A similar association between hyperfiltration and ON-Marg score was observed in multivariable logistic regression. CONCLUSION: Increasing marginalization is significantly associated with both eGFR and hyperfiltration in adolescents with T1D and is associated with significant changes in urinary inflammatory biomarkers. These findings highlight a potentially important interaction between social and biological determinants of health in adolescents with T1D. Mosby 2018-07 /pmc/articles/PMC6016557/ /pubmed/29752172 http://dx.doi.org/10.1016/j.jpeds.2018.03.030 Text en © 2018 The Authors http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Cummings, Laura A.M. Clarke, Antoine Sochett, Etienne Daneman, Denis Cherney, David Z. Reich, Heather N. Scholey, James W. Dunger, David B. Mahmud, Farid H. Social Determinants of Health Are Associated with Markers of Renal Injury in Adolescents with Type 1 Diabetes |
title | Social Determinants of Health Are Associated with Markers of Renal Injury in Adolescents with Type 1 Diabetes |
title_full | Social Determinants of Health Are Associated with Markers of Renal Injury in Adolescents with Type 1 Diabetes |
title_fullStr | Social Determinants of Health Are Associated with Markers of Renal Injury in Adolescents with Type 1 Diabetes |
title_full_unstemmed | Social Determinants of Health Are Associated with Markers of Renal Injury in Adolescents with Type 1 Diabetes |
title_short | Social Determinants of Health Are Associated with Markers of Renal Injury in Adolescents with Type 1 Diabetes |
title_sort | social determinants of health are associated with markers of renal injury in adolescents with type 1 diabetes |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016557/ https://www.ncbi.nlm.nih.gov/pubmed/29752172 http://dx.doi.org/10.1016/j.jpeds.2018.03.030 |
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