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In their study on the use of insulin pumps among children with type 1 diabetes (T1D) in Canada, Ladd et al1 used an interprovincial comparison to examine whether disparities in socioeconomic status (SES) were associated with use of insulin pumps despite government assistance. The authors assessed factors associated with insulin pump uptake in Québec and Manitoba and the use of province-level programs to support the financial costs associated with insulin pump use. The analysis first notes that markers of low SES (measured by material deprivation index) are associated with lower levels of insulin pump uptake in both provinces. Taking advantage of the differential levels of financial support for diabetes management devices between 2 otherwise comparable provinces (ie, similar population level distribution of SES) within the same national health care system, the authors suggest that provision of comprehensive financial support for use of insulin pumps is associated with decreased SES-based disparities in insulin pump uptake in Québec, which provides full coverage, compared with Manitoba, which provides partial support. The authors’ approach to a common limitation in health services research related to health care disparities is creative and mitigates the confounding related to the overlap between cost of diabetes management devices and the association between SES and use of the devices.1 By noting that, even with universal financial coverage for insulin pump–related costs, individuals from neighborhoods with higher levels of material deprivation remained less likely to start using insulin pumps, the authors reported on what eludes health services researchers studying the use of diabetes management devices in countries without such expansive financial support for insulin pumps. This research design supports the conclusion that SES factors other than pure financial cost (ie, parental educational level, employment, race and ethnicity, and family structure) play a greater role in levels of insulin pump uptake than cost alone. The authors aptly characterize this finding in the discussion, stating that “disparities may not be strictly owing to monetary concerns”1 The US literature is lacking in its capacity to separate the association between the cost of devices and family income from other SES variables; although authors have attempted to conduct similar analyses using stratification by insurance type or poverty level, the health care system financing in the US precludes conclusive analyses such as those conducted by Ladd et al.1 However, even with this improved capacity to partially eliminate confounding, the authors were unable to control for what remains a challenging variable to capture and quantify in health care disparities research: implicit bias. Multiple findings within the study suggest the persistence of bias despite financial support (eg, the association between race and ethnicity and insulin pump uptake in Québec); yet, as the authors acknowledge, without explicit data about family preference and/or health care professional biases, they cannot measure its outcome. Studies that establish the role of implicit bias in the uptake of diabetes management devices among pediatric patients with T1D are limited. In one recent study out of Hasbro Children’s Hospital, Fredette et al2 conducted a survey of 192 pediatric endocrinology clinicians across the US and found that 70% reported using personal guidelines to select patients to whom to prescribe insulin pumps. The use of such guidelines, rather than explicit and unbiased criteria, opens the door to unacknowledged implicit biases and more explicit prejudices. Limited studies have begun to investigate the perspectives of patients and families from low SES and diverse backgrounds, and their findings suggest the importance of shared decision-making and understanding of patient and + Related article