Socioeconomic and health disparities among adults diagnosed with type 1 diabetes before age 18

Abstract Background Despite clinical advances, individuals with childhood-onset type 1 diabetes (T1DM) may face long-term socioeconomic and health challenges, but population-based evidence remains scarce. Methods We analyzed data from the Italian PASSI surveillance system (2011-2018, 2023). Adults aged 18-50 self-reporting diabetes diagnosed before age 18 and currently using insulin were classified as T1DM cases and matched 1:2 by age and sex to healthy controls. Outcomes included marital status, employment, financial hardship, self-rated health, and days with physical, mental, or activity impairment. Association between T1DM and the outcomes of interest was evaluated using multivariable logistic regression, adjusting for age and sex. Results were presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). This study was conducted within the framework of the Joint Action on Cardiovascular Diseases and Diabetes (JACARDI). Results Among 319,801 individuals, 331 had T1DM and were matched with 662 controls. T1DM was associated with higher odds of unemployment (aOR 1.57, 95%CI 1.20-2.07), severe financial hardship (aOR 1.81, 95%CI 1.05-3.13), and poor self-rated health (aOR 6.64, 95%CI 2.53-17.43). T1DM individuals more often reported ≥14 days/month of physical (aOR 2.95, 95%CI 1.54-5.65) or mental (aOR 2.16, 95%CI 1.46-3.19) impairment, and activity limitation (aOR 1.73, 95%CI 1.06-2.82). No differences emerged in terms of educational attainment or depression screening. Conclusions Adults with early-onset T1DM experience persistent socioeconomic and health disparities despite similar educational attainment. Integrated, long-term support-including mental health and financial assistance-is needed to mitigate impacts beyond glycemic control. Key messages • Early-onset T1DM is linked to long-term socioeconomic vulnerability and health impairment in adulthood. • Beyond glycemic control, mental health and financial support are crucial for individuals with T1DM.