Low Socioeconomic Status is Associated with Increased Risk for Hypoglycemia in Diabetes Patients: The Diabetes Study of Northern California (DISTANCE)

Social risk factors for hypoglycemia are not well understood. Cross-sectional analysis from the DISTANCE study, a multi-language, ethnically-stratified random sample of adults in the Kaiser Permanente Northern California diabetes registry, conducted in 2005-2006 (response rate 62%). Exposures were i...

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Bibliographic Details
Published in:Journal of health care for the poor and underserved 2014-05, Vol.25 (2), p.478-490
Main Authors: Berkowitz, Seth A, Karter, Andrew J, Lyles, Courtney R, Liu, Jennifer Y, Schillinger, Dean, Adler, Nancy E, Moffet, Howard H, Sarkar, Urmimala
Format: Article
Language:English
Subjects:
Academic achievement
Adult
Aged
California - epidemiology
Cross-Sectional Studies
Diabetes
Diabetes Mellitus, Type 2 - complications
Education
Educational attainment
Educational Status
Female
Health education
Health services
High schools
Humans
Hyperglycemia
Hypoglycemia - economics
Hypoglycemia - epidemiology
Hypoglycemia - etiology
Income
Logistic Models
Low income groups
Low income people
Male
Middle Aged
Monte Carlo simulation
Patients
Population
Response rate
Risk Factors
Socioeconomic Factors
Socioeconomics
Studies
Citations: Items that cite this one
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Summary:Social risk factors for hypoglycemia are not well understood. Cross-sectional analysis from the DISTANCE study, a multi-language, ethnically-stratified random sample of adults in the Kaiser Permanente Northern California diabetes registry, conducted in 2005-2006 (response rate 62%). Exposures were income and educational attainment; outcome was patient report of severe hypoglycemia. To test the association, we used multivariable logistic regression to adjust for demographic and clinical factors. 14,357 patients were included. Reports of severe hypoglycemia were common (11%), and higher in low-income vs. high-income (16% vs. 8.8) and low-education vs. high-education (11.9% vs. 8.9%) groups. In multivariable analysis, incomes of less than $15,000 (OR 1.51 95%CI 1.19-1.91), $15,000-$24,999 (OR 1.57 95%CI 1.27-1.94), and high school or less education (OR 1.42, 95% CI 1.24-1.63) were associated with increased hypoglycemia, similar to insulin use (OR 1.44 95%CI 1.19-1.74). Low income and educational attainment are important risk factors for hypoglycemia.
ISSN:1049-2089
1548-6869
1548-6869
DOI:10.1353/hpu.2014.0106