P-129: Socioeconomic and parental-origin inequities in insulin pump access and glycaemic outcomes in pediatric type 1 diabetes in Sweden
K Åkesson, J Ludvigsson, J HagenAbstract
Introduction
The mechanisms linking socioeconomic disadvantage to poorer glycaemic outcomes in children with type 1 diabetes (T1D) remain insufficiently clarified. It is unclear whether observed disparities reflect differences in disease severity at onset, variation in follow-up intensity, or unequal access to diabetes technologies.
Objectives
To quantify socioeconomic disparities in access to pump therapy, and to assess their contribution to inequalities in glycaemic outcomes.
Methods
We used data from the Swedish National Diabetes Register including 11,031 children 0–18 years diagnosed with T1D 2007–2018, contributing 63,726 child-year observations over the first 5 years after diagnosis. Exposures measured at diagnosis included household education and income, parental origin, and child sex. Outcomes comprised annual mean HbA1c, insulin pump use, CGM use, CGM variability, and number of diabetes clinic contacts. Models adjusted for age at diagnosis, incidence HbA1c and pH, family diabetes history, years since diagnosis, and diagnosis-year fixed effects.
Results
Clear social gradients were observed. Annual pump use was 12.1 % lower among children from the lowest education households, compared with 4.6 % in the lowest income group and 8.4 % among children with non-European parental origin. Similar disparities were found also by year 1 and 2 after diagnosis. In contrast, disadvantaged groups did not have fewer diabetes clinic contacts; children from low-education households had more contacts than the reference group. Children from pre-secondary education households had higher adjusted HbA1c than those from post- secondary households (+3.81 mmol/mol).
Conclusions
Inequities in glycemic outcomes align with unequal access to pump therapy. Parental education was the strongest socioeconomic predictor of pump access, indicating that universal healthcare does not ensure equitable implementation of diabetes technology.