Association Between Social Vulnerability and Achieving Glycemic Control Among Pregnant Individuals With Pregestational Diabetes.
Association Between Social Vulnerability and Achieving Glycemic Control Among Pregnant Individuals With Pregestational Diabetes.
复制标题
妊娠前糖尿病孕妇的社会脆弱性与实现血糖控制之间的关联。
DOI：
10.1097/aog.0000000000004727
复制
发表时间：
2022
影响因子：
7.2
通讯作者：
Fareed,Naleef
中科院分区：
文献类型：
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作者：
Venkatesh,KartikK;Germann,Katherine;Joseph,Joshua;Kiefer,Miranda;Buschur,Elizabeth;Thung,Stephen;Costantine,MagedM;Gabbe,Steven;Grobman,WilliamA;Fareed,Naleef
目的：评估社区水平的社会脆弱性和实现血糖控制（定义为血红蛋白A1 c [Hb A1 c]低于6.0%或低于6.5%）之间的关联与妊娠前diabetes.METHODS：我们进行了一个回顾性队列的个体与单胎妊娠的妊娠前糖尿病从2012年至2016年在三级保健中心。使用ArcGIS对这些数据进行地理编码，然后在人口普查区域与疾病控制和预防中心的2018年SVI（社会脆弱性指数）相关联，该指数包含15个人口普查变量，以产生一个综合得分和四个主题领域的得分（社会经济地位，家庭组成和残疾，少数民族地位和语言，以及住房类型和交通）。分数从0到1不等，数值越高表明社区一级的社会脆弱性越大。主要结果是在第二或第三孕期，Hb A 1c低于6.0%，其次是Hb A 1c低于6.5%。使用具有稳健误差方差的多变量Poisson回归来评估SVI评分（作为连续测量指标）与目标Hb A 1c之间的相关性。结果：在418名评估的怀孕个体中1型占33.0%; 41.4%（173/418）HbA1c <6.0%;平均胎龄为29.5周时，HbA 1c <6.5%者占56.7%（237/418）（SD 5.78）。与SVI评分较低的孕妇相比，SVI评分较高的孕妇HbA 1c低于6.0%的可能性较小。SVI评分每增加0.1个单位，Hb A 1c低于6.0%的风险降低近50%（调整后风险比[aRR] 0.53; 95% CI 0.36-0.77），Hb A 1c低于6.5%的风险降低超过30%（调整后比值比0.67; 95% CI 0.51-0.88）。关于特定的SVI领域，那些在社会经济地位上得分较高的人（aRR 0.50; 95%CI 0.35-0.71）以及家庭组成和残疾（aRR 0.55; 95%CI 0.38-0.79）则不太可能达到HbA 1c低于6.0%。结论：生活在社会脆弱性较高地区的妊娠糖尿病患者不太可能实现血糖控制，通过HgbA 1c水平测量。需要采取干预措施来评估解决健康的社会决定因素是否可以改善妊娠期血糖控制。
OBJECTIVE:To evaluate the association between community-level social vulnerability and achieving glycemic control (defined as hemoglobin A 1c [Hb A 1c] less than 6.0% or less than 6.5%) among individuals with pregestational diabetes.METHODS:We conducted a retrospective cohort of individuals with pregestational diabetes with singleton gestations from 2012 to 2016 at a tertiary care center. Addresses were geocoded using ArcGIS and then linked at the census tract to the Centers for Disease Control and Prevention's 2018 SVI (Social Vulnerability Index), which incorporates 15 Census variables to produce a composite score and four scores across thematic domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation). Scores range from 0 to 1, with higher values indicating greater community-level social vulnerability. The primary outcome was Hb A 1c less than 6.0%, and, secondarily, Hb A 1c less than 6.5%, in the second or third trimesters. Multivariable Poisson regression with robust error variance was used to evaluate the association between SVI score as a continuous measure and target Hb A 1c.RESULTS:Among 418 assessed pregnant individuals (33.0% type 1; 67.0% type 2 diabetes), 41.4%(173/418) achieved Hb A 1c less than 6.0%, and 56.7%(237/418) Hb A 1c less than 6.5% at a mean gestational age of 29.5 weeks (SD 5.78). Pregnant individuals with a higher SVI score were less likely to achieve Hb A 1c less than 6.0% compared with those with a lower SVI score. For each 0.1-unit increase in SVI score, the risk of achieving Hb A 1c less than 6.0% decreased by nearly 50%(adjusted risk ratio [aRR] 0.53; 95% CI 0.36–0.77), and by more than 30% for Hb A 1c less than 6.5%(adjusted odds ratio 0.67; 95% CI 0.51–0.88). With regard to specific SVI domains, those who scored higher on socioeconomic status (aRR 0.50; 95% CI 0.35–0.71) as well as on household composition and disability (aRR 0.55; 95% CI 0.38–0.79) were less likely to achieve Hb A 1c less than 6.0%.CONCLUSION:Pregnant individuals with pregestational diabetes living in an area with higher social vulnerability were less likely to achieve glycemic control, as measured by HgbA1c levels. Interventions are needed to assess whether addressing social determinants of health can improve glycemic control in pregnancy.