Relationship between social determinants of health and quality of life in low income adults with diabetes in Lebanon

Figures & data

Table 1. Sample demographics and quality of life (n = 300).

	M ± SD or %
Age	60.3 ± 12.1
Age (years)
18–49	17
50–64	49.7
65–94	33.3
Sex
Female	48
Male	52
Marital status
Married	73
Not married	27
Education (years)
< high school grad	63.8
≥ high school grad	36.2
Employment
Employed	44.7
Unemployed	55.3
Household Income
<500 USD	30.3
500 USD – 1499 USD	30.7
≥1500 USD	10
Not reported	29
Health Insurance
Yes	46.8
No	53.2
Confident in filling out health forms
Yes	28.8
No	71.2
Quality of life (WHOQOL-BREF)
Physical health	12.9 ± 3.1
Psychological health	13.2 ± 3.0
Social relationships	13.0 ± 3.3
Environment	12.0 ± 2.6
Overall perception of quality of life	2.9 ± 0.9
Overall perception of health	3.2 ± 0.9

*Data is presented as mean ± SD for continuous variables (age and quality of life) and percentage (%) for categorical variables (age, sex, marital status, education, employment, household income, health insurance, and confidence in filling out health forms)

Table 2. Social determinants of health characteristics for study participants (n = 300).

	M ± SD or %
Socioeconomic Status Variables
Family size	4.5 ± 1.9
Financial independence	1.6 ± 1.9
Number of persons per bedroom	2.0 ± 0.9
Number of rooms	3.5 ± 1.5
Financial status
Comfortable; have more than enough to make ends meet	10.5
Have enough to make ends meet	27.8
Do not have enough to make ends meet	61.7
Accommodation
Owned	36
Rented	64
Psychosocial Variables
Diabetes Fatalism (Dfs12)	35.7 ± 7.9
Adverse childhood experience (ACE) Total Score	0.6 ± 1.1
Patient Health Questionnaire (PHQ9) Total Score	7.2 ± 5.1
Neighborhood/Built Environment Variables
Food Insecurity Total Score	1.0 ± 1.8
Electricity
Yes	100
Drinking water
Yes	84.0
Television
Yes	99.3
Cable subscription
Yes	72.0
Telephone
Yes	97.3
Air Conditioner
Yes	61.7
Heater
Yes	82.0
Wireless-internet subscription
Yes	60.0
Computer
Yes	37.7
Refrigerator
Yes	93.3
Means of transportation
Public transportation	34.0
Car	51.0
Walking	12.7

*Data is presented as mean ± SD for continuous variables (family size, financial independence, number of persons per bedroom, number of rooms, diabetes fatalism, ACE, and PHQ9) and percentage (%) for categorical variables (financial status, accommodation, and neighborhood/ built environment variables)

Table 3. Partially adjusted models for correlates of quality of life domains.

Variables	Physical health	Psychological health	Social relationships	Environment	Overall perception of quality of life	Overall perception of health
Age	−.010(−.044; 0.023)	0.01(−0.02; 0.05)	−0.04 (−0.07;-0.0003)*	0.03(0.002;0.056)*	−0.0004(−0.01; 0.01)	0.01(−0.02; 0.02)
Sex Male	0.58(−0.24; 1.39)	0.44(−0.34; 1.22)	−0.25(−1.18; 0.67)	−0.28(−0.95; 0.39)	0.0001(−0.22; 0.22)	−0.19(−0.43; 0.05)
Marital status Married	−0.37(−0.84; 0.77)	0.19(−0.57; 0.96)	0.66(−0.31; 1.62)	−0.15(−0.81; 0.51)	0.04(−0.18; 0.26)	0.05(−0.19; 0.29)
Education ≥ high school grad	0.89(0.08;1.70)*	0.91(0.14;1.67)*	0.36(−0.54; 1.27)	1.07(0.41;1.74)*	0.39(0.17;0.61)*	0.14(−0.01; 0.37)
Employment status Employed	1.16(0.30;2.02)*	0.93(0.10;1.74)*	0.62(0-.35; 1.60)	0.44(−.27; 1.15)	0.06(−0.18; 0.30)	0.55(0.29–0.80)**
Income
500 USD – 1499 USD	1.39(0.44;2.35)*	0.84(−0.08; 1.75)	1.50(0.44;2.57)*	1.33(0.55;2.12)*	0.61(0.35;0.87)**	0.37(0.09–0.65)*
≥1500 USD	1.20(−0.22; 2.61)	1.24(−0.11; 2.59)	1.63(0.07;3.19)*	2.23(1.07;3.40)**	1.00(0.61;1.39)**	0.43(0.01–0.84)*
Not reported	1.09(0.13;2.05)*	0.53(−0.38; 1.43)	−0.28(−1.4; 0.84)	0.99(0.21;1.78)*	0.36(0.10;0.62)*	0.19(−0.09; 0.47)
Health Insurance Yes	−0.25(−0.99; 0.49)	0.21(−0.49; 0.91)	−0.29(−1.13; 0.55)	−0.10(−0.70; 0.51)	0.19(−0.01; 0.39)	−0.004(−0.22; 0.21)
Confident in filling out health forms No	0.67(−0.20; 1.55)	0.27(−0.56; 1.11)	0.47(−0.54; 1.48)	0.67(−0.05; 1.39)	0.15(−0.08; 0.39)	0.80(−0.18; 0.34)

Coefficients of associations (95% CI) are presented. Statistically significant *p < 0.05; **p < 0.001

Models adjusted for age, sex, marital status, education, employment status, monthly income, insurance, and confidence in filling out health forms.

Table 4. Fully adjusted models for correlates of quality of life domains.

Variables	Physical health	Psychological health	Social relationships	Environment	Overall perception of quality of life	Overall perception of health
Age	−0.04(−0.07;-0.009)*	−0.002(−0.29; 0.024)	−0.055 (−0.091;-0.018)*	0.0003(−0.02; 0.02)	−0.007(−0.016; 0.002)	0.004(−0.006; 0.14)
Employment status Employed	0.98(0.17;1.80)*	1.08(0.39;1.77)*	0.84(−0.14; 1.82)	0.33(−0.30; 0.97)	0.06(−0.18; 0.29)	0.50(0.23–0.77)**
Income
500 USD – 1499 USD	0.09(−0.84; 1.03)	−0.15(−0.94; 0.65)	0.50(−0.63; 1.64)	−0.08(−0.81; 0.64)	0.25(−0.02; 0.52)	0.24(−0.08; 0.55)
≥1500 USD	−0.31(−1.78; 1.15)	0.66(−0.59; 1.90)	1.10(−0.63; 2.83)	0.10(−1.04; 1.24)	0.55(0.12–0.97)*	0.25(−0.24; 0.74)
Not reported	0.51(−0.45; 1.48)	0.11(−0.70; 0.93)	−0.73(−1.94; 0.48)	0.33(−0.43; 1.09)	0.17(−0.11; 0.45)	0.12(−0.20; 0.44)
Family size	0.13(−0.18; 0.21)	0.23(0.06;0.40)*	0.27(0.04;0.50)*	−0.05	0.04(−0.02; 0.09)	0.006(−0.06; 0.07)
Insurance	−0.38(−1.08; 0.32)	−0.15(−0.75; 0.44)	−0.15(−0.99; 0.69)	−0.57(−1.11;-0.24)*	0.07(−0.13; 0.27)	−0.05(−0.28; 0.18)
Financial status Do not have enough to make ends meet	−0.82(−2.07; 0.42)	−0.28(−1.34; 0.78)	0.23(−1.27; 1.72)	−1.65(−2.61;-0.67)*	−0.50 (−0.86;-0.14)*	−0.18(−0.60; 0.23)
Financial independence	0.006(−0.18; 0.20)	−0.16(−0.32;-0.001)*	−0.008(−0.23; 0.22)	−0.12(−0.27; 0.02)	−0.08 (−0.14;-0.02)*	−0.04(−0.11; 0.02)
Number of rooms	0.78(−0.18; 0.33)	0.43(−0.17; 0.26)	0.02(−0.28; 0.32)	0.22(0.02;0.42)*	0.038(−0.04; 0.11)	−0.01(−0.10; 0.07)
Adverse Childhood Experience (ACE)	0.25(−0.04; 0.55)	0.14(−0.11; 0.39)	0.039(−0.34; 0.42)	0.27(0.04;0.50)*	0.06(−0.02; 0.15)	0.07(−0.03; 0.17)
Patient Health Questionnaire (PHQ9)	−0.29(−0.36;-0.21)**	−0.30(−0.36;-0.24)**	−0.21(−0.30;-0.13)**	−0.15(−0.21;-0.10)**	−0.04 (−0.06;-0.02)**	−0.057 (−0.081;-0.034)**
Drinking water	0.43(−0.50; 1.37)	0.43(−0.36; 1.23)	1.43(0.30;2.56)*	1.00(0.26;1.73)*	−0.10(−0.37; 0.17)	−0.14(−0.46; 0.17)
Telephone	0.16(−1.98; 2.30)	−2.39(−4.21;-0.57)*	0.08(−2.53; 2.70)	−1.41(−3.26; 0.44)	−0.19(−0.81; 0.43)	−0.39(−1.10; 0.33)
Air Conditioner	0.11(−0.65; 0.88)	0.015(−0.63; 0.66)	0.28(−0.63;1.20)	0.61(0.02;1.21)*	0.15(−0.07; 0.37)	−0.06(−0.31; 0.20)
Heater	0.82(−0.90; 1.73)	0.99(0.22;1.76)*	0.50(−0.62; 1.62)	0.66(−0.05; 1.38)	−0.11(−0.38; 0.15)	0.19(−0.11; 0.49)
Refrigerator	−0.38(−1.89; 1.12)	−1.14(−2.42; 1.39)	−2.05(−3.84;-0.26)*	0.56(−0.61; 1.73)	0.15(−0.28; 0.59)	−0.22(−0.73; 0.28)
Means of transportation
Public transportation	0.19(−0.75; 1.14)	0.66(−0.14; 1.46)	1.50(0.36;2.65)*	−0.089(−0.82; 0.65)	−0.004(−0.28; 0.27)	0.03(−0.29; 0.34)
Car	0.94(−0.03; 1.90)	0.89(0.07;1.71)*	1.10(−0.07; 2.28)	1.12(0.37;1.87)*	0.12(−0.16; 0.40)	−0.002(−0.32; 0.32)

Coefficients of associations (95% CI) are presented. Statistically significant *p < 0.05; **p < 0.001

Models adjusted for age, sex, marital status, education, employment status, monthly income, insurance, confidence in filling out health forms, financial status, family size, financial independence, number of persons per bedroom, number of rooms, diabetes fatalism, adverse childhood experience, depression (PHQ9), food insecurity, home availability of drinking water, television, cable subscription, telephone, air conditioner, heater, wireless-internet subscription, computer and refrigerator, and means of transportation. Primary outcomes are domains of QoL (physical health, psychological wellbeing, social relationships, environment, overall perception of quality of life, and overall perception of health); primary independent variables included SDOH variables (socioeconomic, psychosocial, and neighborhood/built environment); and covariates included age, sex, marital status, education, employment status, monthly income, insurance, and confidence in filling out health forms.