Socioeconomic Status and the Domestic Allocation of Type 1 Diabetes Care


Objective: Few studies explore how socioeconomic status (SES) influences the allocation of type 1 diabetes (T1D) care within households. This study used survey research to better understand the perspectives and experiences of maternal caregivers who have adolescents with T1D.

Research Design and Methods: Survey research with open-ended sections was conducted with women who lives with another adult partner and had cull custody of an adolescent 12-19 with T1D. Demographic information included age, gender, race-ethnicity, martial status, education level, occupation, and household income. Disease duration and youth HbA1c levels were also captured.

Results: Forty-six caregivers completed surveys. Care allocation, diabetes strain, and parenting strategies were compared by income categories and exhibited variation accordingly. Women from households with income <$40,000, classified as low socio-economic status or less affluent, tended to report sharing diabetes-related responsibilities equally with partners; tended to hold full-time, low-wage positions; and noted stress associated with inflexible jobs and financial concerns. Women from households with incomes $80,000 or higher, classified as high socioeconomic status or more affluent, more commonly described primary caregiving, professional status changes, and difficulty transferring control to their teens.

Conclusion: These findings indicate significant, yet varying, strain for women from different SES thresholds that deserves further attention. For female caregivers of adolescents with T1D, the unequal distribution of labor associated with care-related demands may contribute to outcomes like depression, anxiety, and familial conflict.  Providers should be acutely aware of the toll that care-related demands may take on women and have information readily available on support groups and mental health services.

Author Biographies

Ashby F. Walker, PhD, University of Florida

Ashby Walker, PhD serves as the Director for Health Equity Initiatives at the University of Florida Diabetes Institute.  She is an elected member of the American Diabetes Association National Health Disparities Committee and the Type 1 Exchange National Racial Disparities Working Group.  Dr. Walker's area of focus as a medical sociologist is on reducing health disparities in pediatric Type 1 diabetes and the role that social capital plays in informing childhood inequalities in health outcomes. 

Desmond A. Schatz, MD, University of Florida
Desmond Schatz, MD is Professor and Associate Chairman of Pediatrics, Medical Director of the UF Diabetes Institute, and Associate Director of the Clinical Research Center, at the University of Florida, Gainesville. His primary research is in Type 1 diabetes with a focus on the prediction, natural history, and prevention of the disease, as well as the management of children and adolescents with Type 1 diabetes. He served as the President of Medicine and Science for the American Diabetes Association in 2016.
Cathryn Johnson, PhD, Emory University
Cathryn Johnson, PhD serves as the Senior Associate Dean of the Laney Graduate School at Emory University and Professor in the Department of Sociology.  Her expertise includes social psychology, organizations, identity processes, and emotions, with special emphasis on the study of legitimacy processes within groups and organizations.
Henry J. Rohrs, MD, University of Florida
Henry Rohrs, MD serves as Associate Professor in the Department of Pediatrics at the University of Florida in the College of Medicine.  He is the Associate Director for the Pediatric Residency Program.  His areas of research focus on various aspects of endocrine diseases and also psychosocial experiences and complications related to Type 1 diabetes.
Kelsey R. Salazar, MPH, University of Florida
Kelsey Salazar, MPH works with the University of Florida’s Institute for Child Health Policy on External Quality Review projects evaluating children’s public health insurance programs in the state of Florida. She also contributes to research projects related to health disparities in pediatric type 1 diabetes.
Original Research Articles