A Khanolkar

Socioeconomic position and the risk of brain tumour: a Swedish national population-based cohort study

Background The aim was to investigate associations between different measures of socioeconomic position (SEP) and incidence of brain tumours (glioma, meningioma and acoustic neuroma) in a nationwide population-based cohort. Methods We included 4 305 265 individuals born in Sweden during 1911–1961, and residing in Sweden in 1991. Cohort members were followed from 1993 to 2010 for a first primary diagnosis of brain tumour identified from the National Cancer Register. Poisson regression was used to compute incidence rate ratios (IRR) by highest education achieved, family income, occupational group and marital status, with adjustment for age, healthcare region of residence, and time period. Results We identified 5735 brain tumours among men and 7101 among women during the study period. Highly educated men (≥3 years university education) had increased risk of glioma (IRR 1.22, 95% CI 1.08 to 1.37) compared to men with primary education. High income was associated with higher incidence of glioma in men (1.14, 1.01 to 1.27). Women with ≥3 years university education had increased risk of glioma (1.23, 1.08 to 1.40) and meningioma (1.16, 1.04 to 1.29) compared to those with primary education. Men and women in intermediate and higher non-manual occupations had increased risk of glioma compared to low manual groups. Compared to those married/cohabiting, being single or previously married/cohabiting was associated with decreased risk of glioma in men. Men in non-manual occupations had ∼50% increased risk of acoustic neuroma compared to men in low manual occupations. Conclusions We observed consistent associations between higher SEP and higher risk of glioma. Completeness of cancer registration and detection bias are potential explanations for the findings.

Ethnic differences in early glycemic control in childhood-onset type 1 diabetes

Some ethnic minorities with type 1 diabetes (T1D) have worse glycemic control (higher glycated hemoglobin (HbA1c)) and increased risk for vascular complications. There is limited evidence on the impact of ethnicity on early glycemic control when most patients experience transient remission postdiagnosis. We examined associations between ethnicity and longitudinal HbA1c trajectories during the first 6 months postdiagnosis in a multiethnic cohort in East London. Research design and methods Data on 443 (50% female) children <19 years of age, with T1D and attending one of three clinics in East London between January 2005 and December 2015 were included. Linear mixed-effects modeling was used to assess ethnic differences in longitudinal HbA1c trajectories during the first 6 months postdiagnosis (1,028 HbA1c data points), adjusting for sex, age at diagnosis, socioeconomic status and pH at diagnosis. Growth curve modeling was used to plot discrete HbA1c trajectories by ethnicity. Results Longitudinal modeling revealed that all ethnic minorities had higher mean HbA1c at diagnosis compared with White children and highest in Bangladeshi (9.7 mmol/mol, 95% CI 5.1 to 14.3), Asian-Other (5.8 mmol/mol, 95% CI 2.2 to 9.3) and Somali (5.2 mmol/mol, 95% CI 0.1 to 10.2) children, and these differences persisted over the 6-month period after diagnosis. During the first month, HbA1c decreased on average by 19.6 mmol/mol (95% CI −21 to −18) for all children. Population averaged HbA1c decreased between diagnosis and 4 months, followed by a gradual increase in HbA1c levels (mean difference of −30 mmol/mol between diagnosis and 6 months). Conclusions Ethnic minorities present with higher HbA1c at diagnosis, with the largest mean differences observed in Bangladeshi, Asian-Other and Somali children. These higher levels (indicating poorer glycemic control) track into the first 6 months postdiagnosis.

OP27 Socioeconomic position and mortality from brain tumour – a swedish population-based study

Background Socioeconomic disparities in mortality from various cancers are well documented with patients from lower socioeconomic background having an increased risk for mortality. However, similar evidence on differences in mortality from tumours of the central nervous system is both limited and conflicting. We investigated associations between socioeconomic factors (education, income and marital status) and mortality after a brain tumour diagnosis. Methods The study included all patients diagnosed with a primary brain tumour in Sweden between 1993–2010 as reported to the national cancer register and were followed-up until 31 st December 2015. Data on education, disposable income and marital status were obtained via linkage with national registers. We used flexible parametric models with restricted cubic splines to estimate the excess hazard ratio [EHR] (the analogue of relative survival) by socioeconomic factors for glioma, glioblastoma and meningioma. Models were adjusted for age at diagnosis, tumour location, healthcare region and country of birth, and run separately for men and women. Results 6075 men and 7831 women developed a brain tumour during the study period. 4197 (69%) men and 3370 (43%) women died by the end of follow-up. Men and women with primary education had increased mortality from glioma (EHR, 1.13, 95% CI 1.04–1.24, and 1.11, 1.00–1.24) and glioblastoma (EHR 1.20, 1.07–1.35 and 1.14, 1.00–1.31 respectively) compared to those with university education. Men in the lowest quartile of income had 29% and 25% higher mortality from glioma and glioblastoma compared to those in the highest income quartile (EHR 1.29, 1.17–1.43 and 1.25, 1.10–1.42 respectively). Women in the lowest quartile of income had higher mortality from meningioma than those in the highest quartile (EHR 3.63, 1.76–7.52). Being single (EHR, 1.15, 1.04–1.26 and 1.21, 1.06–1.38 for men and women respectively) and widowed (EHR, 1.30, 1.08–1.58 and 1.14, 1.00–1.30 for men and women respectively) was associated with increased mortality from glioma. Similarly, being single was associated with increased mortality from meningioma in men (EHR 2.49, 1.42–4.36) and women (EHR 2.10, 1.18–3.73). Conclusion While lower education and low income are associated with increased mortality from glioma in men, only lower education is associated with increased mortality from glioma in women. Low income was associated with increased mortality from meningioma in women only. Being single or widowed were associated with increased mortality from glioma and meningioma in both sexes. These disparities were observed despite access to a universal healthcare system. Earlier detection in individuals from higher socioeconomic groups could be a potential explanation.

Diabetic Ketoacidosis Severity at Diagnosis and Glycaemic Control in the First Year of Childhood Onset Type 1 Diabetes—A Longitudinal Cohort Study

It is unclear whether diabetic ketoacidosis (DKA) severity at diagnosis affects the natural history of type 1 diabetes (T1D). We analysed associations between DKA severity at diagnosis and glycaemic control during the first year post-diagnosis. We followed 341 children with T1D, <19 years (64% non-white) attending paediatric diabetes clinics in East London. Data were extracted from routine medical registers. Subjects were categorized with normal, mild, moderate, or severe DKA. Linear mixed-effects modelling was used to assess differences in longitudinal HbA1c trajectories (glycaemic control) during 12 months post-diagnosis (1288 HbA1c data-points) based on DKA, adjusting for sex, age, ethnicity, SES (Socioeconomic Status) and treatment type. Females (OR 1.6, 95% CI 1.1–2.4) and younger age, 0–6 vs. 13–18 years (OR 2.9, 95% CI 1.5–5.6) had increased risk for DKA at diagnosis. Moderate or severe DKA was associated with higher HbA1c at diagnosis (adjusted estimates 8 mmol/mol, 2–14, and 10 mmol/mol, 4–15, respectively, compared to normal DKA). Differences in HbA1c trajectories by DKA were no longer apparent at six months post-diagnosis. All subjects experienced a steep decrease in HbA1c during the first three months followed by a gradual increase. While, DKA severity was not associated with glycaemic control at 12 months post-diagnosis, age at diagnosis, ethnicity, gender, and treatment type were significantly associated. For example, Black and mixed ethnicity children had increased risk for poor glycaemic control compared to White children (adjusted RRR 5.4, 95% CI 1.7–17.3 and RRR 2.5, 95% CI 1.2–6.0, respectively). DKA severity at diagnosis is associated with higher initial HbA1c but not glycaemic control from six months post-diagnosis. Age at diagnosis, ethnicity, gender, and insulin pump are associated with glycaemic control at one year post-diagnosis.

G443 Greater prevalence of type 2 diabetes and poorer glycaemic control among ethnic minority children in England and Wales

Background Ethnic minority children are at greater risk for type 2 diabetes. The current prevalence of type 2 diabetes in children in England and Wales is not known. Additionally, very little is known on glycaemic control in paediatric type 2 diabetes globally. Methods Using data from the National Paediatric Diabetes Audit (NPDA) for 2012–13, we estimated A. The overall, gender- and ethnic-specific prevalence of type 2 diabetes in children <16 years and B. Whether ethnicity predicts glycaemic control (mean HbA1c) in children <19 years. Ethnicity was self-identified and categorised into White, Asian, Black, Mixed, Other and ’Not-stated’. Multivariable linear regression was used to estimate differences in glycaemic control by ethnicity adjusting for socioeconomic status, age, diabetes duration and gender. Results 307 children <16 years were identified with type 2 diabetes in 2012–13. The table shows prevalence estimates by gender and ethnicity. Overall prevalence of type 2 diabetes was 2.9/100,000 with females having a higher prevalence than males (4.3 vs. 1.5/100,000). Asians had greater than five-fold increased prevalence of type 2 diabetes compared to White children (8 vs. 1.4/100,000). The highest prevalence of type 2 diabetes was found in Asian (12.2/100,000) followed by Mixed-ethnicity (4.4/100,000) females. White males had the lowest prevalence (0.6/100,000). Mixed-ethnicity children had the highest mean HbA1c (83mmol/mol) compared to other groups; White (62 mmol/mol), Asian (65 mmol/mol), Black (63 mmol/mol), Other (66 mmol/mol) and Not-stated (61 mmol/mol). In regression analysis, Mixed-ethnicity children had the highest HbA1c levels (adjusted mean difference with the White group was 22.3 mmol/mol, 95% CI 10.9–33.6), with no significant differences observed in other ethnic groups.Abstract G443 Table 1 Prevalence of type 2 diabetes by gender and ethnicity among children under 16 years of age in England and Wales Conclusion Children of all ethnic-minorities have an increased prevalence of type 2 diabetes compared to White children, with Asian females being particularly affected. Results indicate a significant increase in paediatric type 2 diabetes over the past decade. Those belonging to mixed-ethnic backgrounds had the poorest glycaemic control.

G476 Diabetes mortality trends 1990 to 2010 in the uk compared with the eu15 and the usa

Aims We investigated whether the UK has higher child and youth diabetes mortality than in comparable European countries and the USA. Methods We obtained data from the WHO World Mortality Database for the UK, the USA and the EU15+ (the 15 countries of the EU in 2004 plus Australia, Canada and Norway) for 1990 to 2010. Diabetes mortality rates were calculated for 1–14 and 15–24 year olds. Multilevel longitudinal Poisson regression models were constructed including all country-level data from 1990–2010 (378 country years) comparing the UK with the EU15+ and the USA. Graphics show average mortality across the EU15+. Results Mortality trends are shown in Figure 1 for 1–14 year olds (both sexes) and Figure 2 (males) and Figure 3 (females) for 15–24 year olds. In 1990 the UK had higher mortality than the EU15+ amongst 1–14yo (p = 0.004) but not amongst 15–24yo (p > 0.2 both sexes). Diabetes mortality did not significantly change in the EU15+ across the study period in any age group. In contrast, amongst 1–14 year olds the UK had a significantly higher rate of decline than the EU15+ (negative slope coefficient, p = 0.03). UK mortality rose amongst 15–24 year olds compared with the EU15+ (positive slope coefficients, p < 0.0001 both sexes) In 1990, the UK had higher diabetes mortality than the US in 1–14 year olds (p < 0.0001) but lower amongst 15–24 year olds (p < 0.0001 both sexes). The USA had little change in diabetes mortality amongst 1–14 year olds but a significant rise in diabetes mortality amongst 15–24 year olds (p < 0.0001 both sexes). The UK had a greater rate of mortality decline that the USA amongst 1–14 year olds (negative slope coefficient p < 0.0001) but rising mortality amongst 15–24 year olds (positive slope, p < 0.0001 both sexes). Abstract G476 Figure 1 Total diabetes mortality amongst 1–14 year olds (3 year moving averages) Abstract G476 Figure 2 Total diabetes mortality amongst 15–24 year males (3 year moving averages) Abstract G476 Figure 3 Total diabetes mortality amongst 15–24 year females (3 year moving averages) Discussion Diabetes mortality in the UK for children 1–14 years approximates the EU15+ mean and is better than in the USA. However, for 15–24 year olds, the UK has high and rising diabetes mortality compared with the EU15+ from 2000 onwards. Further work is needed to understand the contributions of healthcare factors to the UK’s poor diabetes mortality record amongst young people.

Young people with type 1 diabetes of non-white ethnicity and lower socioeconomic status have poorer glycaemic control in England and Wales - a national population-based study

We studied 18,478 children with T1D aged <19 years attending clinics in England & Wales & included in the 201213 National Paediatric Diabetes Audit (NPDA). Selfidentified ethnicity was categorized as White, Asian, Black, Mixed, Other & ‘Not Stated’. SES was estimated using postcode based Index of Multiple Deprivation (in quintiles). Multivariable linear regression was used to assess associations between ethnicity, SES & glycaemic control (mean HbA1c) accounting for age, gender & diabetes duration. Associations between SES & HbA1c were tested in models stratified by ethnicity. The impact of insulin pump use on the ethnicity/SES – HbA1c associations was tested in 13,962 children.