Socioeconomic inequalities in mortality, morbidity and diabetes management for adults with type 1 diabetes: A systematic review

PLoS One. 2017 May 10;12(5):e0177210. doi: 10.1371/journal.pone.0177210. eCollection 2017.


Aims: To systematically review the evidence of socioeconomic inequalities for adults with type 1 diabetes in relation to mortality, morbidity and diabetes management.

Methods: We carried out a systematic search across six relevant databases and included all studies reporting associations between socioeconomic indicators and mortality, morbidity, or diabetes management for adults with type 1 diabetes. Data extraction and quality assessment was undertaken for all included studies. A narrative synthesis was conducted.

Results: A total of 33 studies were identified. Twelve cohort, 19 cross sectional and 2 case control studies met the inclusion criteria. Regardless of healthcare system, low socioeconomic status was associated with poorer outcomes. Following adjustments for other risk factors, socioeconomic status was a statistically significant independent predictor of mortality in 9/10 studies and morbidity in 8/10 studies for adults with type 1 diabetes. There appeared to be an association between low socioeconomic status and some aspects of diabetes management. Although only 3 of 16 studies made adjustments for confounders and other risk factors, poor diabetes management was associated with lower socioeconomic status in 3/3 of these studies.

Conclusions: Low socioeconomic status is associated with higher levels of mortality and morbidity for adults with type 1 diabetes even amongst those with access to a universal healthcare system. The association between low socioeconomic status and diabetes management requires further research given the paucity of evidence and the potential for diabetes management to mitigate the adverse effects of low socioeconomic status.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Diabetes Mellitus, Type 1 / epidemiology
  • Diabetes Mellitus, Type 1 / mortality*
  • Diabetes Mellitus, Type 1 / therapy*
  • Disease Management
  • Health Services Accessibility
  • Humans
  • Risk Factors
  • Social Class
  • Socioeconomic Factors*

Grant support

This work was supported by the Economic and Social Research Council ( [Grant No: ES/I022740/1]. AS was awarded a full time PhD studentship from the ESRC. The research was supported by the NIHR School for Public Health Research (SPHR) ( AS received a salary funded by the NIHR SPHR during 2016 to carry out the current review. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. NIHR SPHR is a collaboration between: the Universities of Sheffield, Bristol, Cambridge, Exeter, UCL; The London School of Hygiene and Tropical Medicine; the LiLaC collaboration between the Universities of Liverpool and Lancaster and Fuse: The Centre for Translational Research in Public Health, a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.