Social Determinants of Health and Epigenetic Age Acceleration in Type 2 Diabetes: A Systematic Review

Background Individuals with type 2 diabetes (T2D) experience epigenetic age acceleration (EAA), as described by DNA methylation based epigenetic clocks. It is critical to examine relationships between social determinants of health (SDOH) and EAA in people living with T2D to understand mechanisms interconnecting social and biologic drivers of health disparities. The purpose of this systematic review was to describe the role of SDOH as factors influencing EAA in T2D. Methods PubMed, CINAHL, and Embase were comprehensively searched. Research reports were independently screened and abstracted; quality was assessed using JBI checklists. The Healthy People 2030 SDOH Framework guided this study. Domains of SDOH were benchmarked against the framework to identify roles and gaps. Results Of 25 included research reports which evaluated epigenetic aging in T2D, 64% describe at least one SDOH. SDOHs within education access and quality (44%), neighborhood and built environment (40%), and economic stability (36%) domains are the most well represented; however, the depth and breadth of conceptual understanding were limited. Concepts representative of SDOH including childhood low socioeconomic status and victimization, trauma, and lower education and income were positively associated with EAA in T2D. Discussion While SDOH are increasingly included in studies of EAA in people with T2D, critical gaps in understanding the roles and relationships between SDOH and EAA were revealed. Findings support the need to move further than socioeconomic status to comprehensively explore SDOH domains influencing EAA in individuals living with T2D, which will provide a framework for identifying health inequities.