Are social determinants of health associated with the development of early complications among young adults with type 2 diabetes? A population based study using linked databases

Prim Care Diabetes. 2023 Apr;17(2):168-174. doi: 10.1016/j.pcd.2023.01.002. Epub 2023 Jan 18.


Aims: To quantify the impact of social determinants of health (SDOH) on top of medical determinants on the development of diabetes-related complications in young adults with type 2 diabetes.

Methods: In this observational population-based study, SDOH (income and origin) were linked to routine primary care data. Young adults (18-45 years) with incident type 2 diabetes between 2007 and 2013 were included. The main outcome, the development of the first micro- or macrovascular complication, was analyzed by multivariate Cox regression. Medical determinants included antidiabetic treatment, HbA1c in the year after diagnosis, body mass index, comorbidity and smoking.

Results: Of 761 young adults (median age: 39 years (IQR 33-42), men: 49%, Western origin: 36%, low income: 48%), 154 developed at least one complication (median follow-up 99 months (IQR 73-123)). Young men of non-Western origin were more likely to develop a complication (HR 1.98 (1.19-3.30)), as were young adults with HbA1c > 7% (>53 mmol/mol) (HR: 1.72 95% CI: 1.15-2.57). No associations were found with income. Being women was protective.

Conclusion: In this multi-ethnic population, non-Western origin was associated with the development of complications, but only in men. Low income was not associated with developing complications. The importance of adequate HbA1c regulation was re-emphasized by this study.

Keywords: Diabetes complications; Routine care data; Social determinants of health; Type 2 diabetes; Young adults.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Diabetes Complications*
  • Diabetes Mellitus, Type 2* / complications
  • Diabetes Mellitus, Type 2* / diagnosis
  • Diabetes Mellitus, Type 2* / epidemiology
  • Female
  • Glycated Hemoglobin
  • Humans
  • Hypoglycemic Agents
  • Male
  • Social Determinants of Health
  • Young Adult


  • Glycated Hemoglobin
  • Hypoglycemic Agents