(367) Area-Based Socioeconomic Deprivation Indices to Predict Glycemic Control in Pregnant Patients with Type 1 Diabetes

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Talia Suner, MD

Maternal Fetal Medicine Fellow
Ochsner Clinic
New Orleans, Louisiana, United States

Coauthor(s)

KJ

Kali M. Juracek, MD

Post-doctoral research fellow
Ochsner Clinical School
New Orleans, Louisiana, United States
James D. Toppin, MD, MPH

Ochsner Health
New Orleans, Louisiana, United States
Joseph R. Biggio, Jr., MD, MSc (he/him/his)

System Chair, Women's Services
Ochsner Health
New Orleans, Louisiana, United States
Shannon McCloskey, MD

Fellow
Ochsner Clinic Foundation
New Orleans, Louisiana, United States
Frank B. Williams, MD, MPH (he/him/his)

Ochsner Clinic Foundation
New Orleans, Louisiana, United States

Objective: Area Deprivation Index (ADI) and Social Vulnerability Index (SVI), indicators of socioeconomic disadvantage, have been associated with adverse outcomes. The inclusion of demographic and economic variables differs between the two indices, potentially affecting the strength of the association with some conditions. We sought to determine if Area Deprivation Index (ADI) or Social Vulnerability Index (SVI) better predicts glycemic control in pregnant patients with type one diabetes mellitus (T1DM).

Study Design: We performed a retrospective cohort study of pregnant patients with singleton gestations and T1DM receiving care at a large regional health system from January 2016 to January 2023. Patients establishing care after 20 weeks and those with missing delivery information were excluded. Primary outcome was optimal baseline glycemic control, defined as HbA1c < 6.5%. Area under the curve (AUC) was calculated to examine the ability of each index to predict optimal glycemic control. Secondary outcomes included midtrimester HbA1c < 6.0%, delivery < 34 weeks and non-transfusion severe maternal morbidity (SMM). Outcomes were compared via regression analyses controlling for individual level deprivation as indicated by public insurance.

Results: Among 288 patients, 144 (50%) had public insurance, with those patients more likely to be younger (median age 26 vs 31, p < 0.001) and Black (52% vs 17%, p < 0.001, Table). Public insurance was associated with lower odds of optimal HbA1c (5.6% vs 29.2%, p < 0.001). Controlling for payor status, ADI was associated with baseline glycemic control (p=0.006) while SVI was not (p=0.36). The AUC for prediction of optimal baseline HbA1c was similar for ADI and SVI when paired with payor status (Figure). ADI, but not SVI, was predictive of midtrimester glycemic control (ADI p=0.013, SVI p=0.098). Neither ADI nor SVI was associated with SMM or delivery < 34 weeks after controlling for payor.

Conclusion: Neighborhood deprivation defined by ADI, but not SVI, was associated with glycemic control after controlling for individual-level income status in pregnant patients with T1DM.