Health Disparities Among Youth With Type 1 Diabetes: A Systematic Review of the Current Literature

Introduction: Research in pediatric Type 1 diabetes (T1D) has reliably identified differences in health outcomes based on race/ethnicity and socioeconomic status (SES). Racial/ethnic minority and/or low-SES youth consistently display poorer physical health and psychological functioning than racial/ethnic majority and higher-SES youth. The purpose of this review is to better understand health disparities in T1D by race/ethnicity and SES, and to provide recommendations for researchers based on these findings. Methods: Articles were obtained from PsycINFO, PubMed, and Web of Knowledge with search terms: Type 1 diabetes, ethnic, pediatric, race/ethnicity, race, socioeconomic status, SES, and income. Criteria for inclusion were (a) Type 1 diabetes cases, (b) child or adolescent samples, (c) information about health or psychosocial outcomes grouped by race/ethnicity or SES, (d) no intervention data, (e) peer-reviewed, (f), English-language, and (g) published in an academic journal. Results: Twenty-seven articles reported on health outcomes and 4 articles reported on psychosocial outcomes. Across 16 studies, racial/ethnic minority youth displayed higher HbA1c levels compared to Caucasian youth. Eighteen studies reported that lower-SES youth had higher HbA1c levels than higher-SES youth. Four studies found racial/ethnic minority youth and lower-SES youth had poorer psychological functioning than Caucasian youth or higher-SES youth. Discussion: Findings from our review suggest an association between race/ethnicity, SES, and health outcomes in pediatric T1D. Researchers should consider developing interventions that take into account factors which may place children from racial/ethnic minority and lower-SES backgrounds at risk for poor metabolic control and emotional functioning. Future research should examine causative mechanisms of health disparities.