Census Tract SES Coding to Assess Impact of the Pandemic on Care of Youth with T1D

The pandemic required altering care delivery to a hybrid model of telehealth and in-person visits. We evaluated if SES disparities during the pandemic impacted clinical visit adherence and CGM device use in youth with T1D. Retrospective EHR captured data on youth with T1D, ≤18 years old, with ≥1 clinical visit both pre-pandemic (9/15/18-3/15/20) and during the pandemic (4/1/20-12/22/21) . Patient addresses were geocoded to link with census tract SES measures from the 20American Community Survey. Low education status defined as ≥30% of residents having HS or lower education and low income as median household income ≤$40,000. Poisson and logistic regression models assessed appointment adherence and CGM device use, respectively, during the pandemic vs. pre-pandemic. Models were adjusted for age, gender, baseline A1c, and T1D duration. In both periods, 689 youth (age 13.8±3.3 years; male 49%; T1D duration 7.4 ±3.6 years) had clinical encounters. There were more visits in the pandemic vs. pre-pandemic (8 [IQR 5-11] vs. 6 [IQR 5-9], p<.001) . In adjusted models, youth living in tracts with low education or low income had 1.16x (95% CI 1.06-1.27, p-.002) and 1.20x (95% CI 1.09-1.32, p<.001) ,respectively, greater rates of increased visits during the later time period vs. those not living in lower education or income tracts. W/R to CGM use, 57% (n=392) used CGM pre-pandemic and 21% (n=83) stopped using CGM during the pandemic. In adjusted models, youth in tracts with low vs. high education had 2.81-fold increased odds (95% CI 1.56-5.07, p<.001) of stopping CGM during the pandemic. Similarly, youth from low vs. high income tracts had 2.49-fold increased odds (95% CI 1.39-4.46, p<.001) of stopping CGM. These data indicate variability in appointment adherence and CGM use during the pandemic based on census SES status. Vulnerable youth by SES factors appear to benefit from hybrid care model W/R to maintaining visits, although such youth appear more likely to stop CGM. Further research is needed further reduce health disparities. Disclosure A.Adam: None. C.Chen: None. S.Ojukwu: None. T.Kaushal: None. L.J.Tinsley: None. L.K.Volkening: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc.