Assessing the impact of social determinants of health on diabetes severity and management

Objective: Adverse Social Determinants of Health (SDoH) are considered major obstacles to effective management of type-2 diabetes. This study aims to quantify the impact of SDoH factors on diabetes management outcomes. Materials and Methods: We quantified the joint impact of multiple SDoH by applying a self-control case series method-which accounts for confounding by using individuals as their own control-to electronic health record data from an academic health system in Maryland. Results: We found a consistent increase in HbA1c levels associated with SDoH across alternative study designs. The estimated total contributions of SDoH ranged 0.014-0.065 across the alternative designs. Transportation issues demonstrated particularly significant contributions, with estimates of 0.077-0.144. When assuming SDoH's risk window to be ±45 days, for example, the total contribution was estimated to be 0.065 (95% CI [0.010, 0.120]) increase in HbA1c and the transportation issues' contribution 0.134 (95% CI [0.020, 0.249]). Discussion and Conclusion: Our result suggests that reducing transportation barriers may be an effective SDoH intervention strategy for diabetes management; however, the clinical impact of such interventions warrants further investigation.