چکیده (انگلیسی):

Background:Hgb A1c levels may be higher in persons without diabetes of lower socio-economic status (SES) but
evidence about this association is limited; there is therefore uncertainty about the inclusion of SES in clinical
decision support tools informing the provision and frequency of Hgb A1c tests to screen for diabetes. We studied
the association between neighborhood-level SES and Hgb A1c in a primary care population without diabetes.
Methods:This is a retrospective study using data routinely collected in the electronic medical records (EMRs) of
forty six community-based family physicians in Toronto, Ontario. We analysed records from 4,870 patients without
diabetes, age 45 and over, with at least one clinical encounter between January 1st 2009 and December 31st 2011
and one or more Hgb A1c report present in their chart during that time interval. Residential postal codes were used
to assign neighborhood deprivation indices and income levels by quintiles. Covariates included elements known to
be associated with an increase in the risk of incident diabetes: age, gender, family history of diabetes, body mass
index, blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, and fasting blood glucose.
Results:The difference in mean Hgb A1c between highest and lowest income quintiles was−0.04% (p = 0.005,
95% CI−0.07% to−0.01%), and between least deprived and most deprived was−0.05% (p = 0.003, 95% CI−0.09%
to−0.02%) for material deprivation and 0.02% (p = 0.2, 95% CI−0.06% to 0.01%) for social deprivation. After
adjustment for covariates, a marginally statistically significant difference in Hgb A1c between highest and lowest
SES quintile (p = 0.04) remained in the material deprivation model, but not in the other models.
Conclusions:We found a small inverse relationship between Hgb A1c and the material aspects of SES; this was
largely attenuated once we adjusted for diabetes risk factors, indicating that an independent contribution of SES to
increasing Hgb A1c may be limited. This study does not support the inclusion of SES in clinical decision support
tools that inform the use of Hgb A1c for diabetes screening.