The association of children and their educational attainment with diabetes-related complications and mortality among older adults with type 2 diabetes: A nationwide cohort study

Socioeconomic resources and family support have been shown to improve adherence to treatment in people with type 2 diabetes (T2D), which is associated with a lower risk of diabetes-related complications and death. We investigated the associations of having children and their educational level with diabetes-related complications and death among older adults with T2D. We included 74,588 adults aged ≥65 years at the time of T2D diagnosis over the period 2000-2018 in Denmark and grouped them based on having children (yes [reference]/no), and their children’s highest educational level (low/medium/high [reference]). Multi-state models were performed with three states: T2D diagnosis, diabetes-related complication, and death. All models were stratified by other chronic diseases at baseline (yes/no). During follow-up (mean: 5.5 years), 14.6% developed a complication and 24.8% died with or without complication. Not having children was associated with a higher hazard of death without complication among adults without (HR: 1.25 [95%CI: 1.17;1.33]) and with chronic diseases (HR: 1.10 [95%CI: 1.02;1.18]) and after complication among adults without chronic diseases (HR: 1.25 [95%CI: 1.12;1.38]). Having children with lower educational levels was associated with higher hazards of complication (HRlow: 1.14 [95%CI: 1.05;1.24] & HRmedium: 1.11 [95%CI: 1.05;1.17]), death without (HRlow: 1.26 [95%CI: 1.17;1.36] & HRmedium: 1.07 [95%CI: 1.02;1.14]) and after complication (HRlow: 1.22 [95%CI: 1.07;1.39]) among adults without chronic diseases. Having no children and children with lower educational levels were associated with higher hazards of complication and death among adults without other chronic diseases.