Rincon O, Uscategui C, Mancera P, Luna M, Rodriguez A, Alvarez M, Guzman I. Association of social determinants of health and cardiovascular complications in type 2 diabetes in Colombia. World J Diabetes 2025; 16(8): 106927 [DOI: 10.4239/wjd.v16.i8.106927]
Corresponding Author of This Article
Mauricio Alvarez, MD, Chief Physician, Department of Endocrinology, Hospital Militar Central, Carrera 7a n 94 a 47, Bogota 110221, Colombia. mauricioalvarez613@gmail.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. Aug 15, 2025; 16(8): 106927 Published online Aug 15, 2025. doi: 10.4239/wjd.v16.i8.106927
Association of social determinants of health and cardiovascular complications in type 2 diabetes in Colombia
Oswaldo Rincon, Catalina Uscategui, Pedro Mancera, Maria Luna, Alba Rodriguez, Mauricio Alvarez, Isaac Guzman
Oswaldo Rincon, Alba Rodriguez, Mauricio Alvarez, Isaac Guzman, Department of Endocrinology, Hospital Militar Central, Bogota 110221, Colombia
Catalina Uscategui, Department of Epidemiology, Hospital Militar Central, Bogota 110221, Colombia
Pedro Mancera, Maria Luna, Department of Endocrinology, Universidad Militar Nueva Granada, Bogota 110221, Colombia
Author contributions: Rincon O, Uscategui C, and Mancera P contributed to the study conception and design; Luna M and Rodriguez A contributed to data collection and initial data analysis; Alvarez M and Guzman I assisted with the interpretation of data and critical revision of the manuscript for important intellectual content; Mancera P drafted the manuscript; All authors reviewed and approved the final version of the manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of the Hospital Militar Central, No. 2022129.
Informed consent statement: This study was a retrospective analysis of clinical history and did not involve identifying the research subjects or their sensitive behaviors. After evaluation by the Ethics Committee of the Hospital Militar Central, the informed consent form was waived.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets analyzed during the current study are not publicly available due to institutional policies on data confidentiality, but they are available from the corresponding author upon reasonable request and with permission from the Hospital Militar Central.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mauricio Alvarez, MD, Chief Physician, Department of Endocrinology, Hospital Militar Central, Carrera 7a n 94 a 47, Bogota 110221, Colombia. mauricioalvarez613@gmail.com
Received: March 11, 2025 Revised: May 4, 2025 Accepted: June 24, 2025 Published online: August 15, 2025 Processing time: 156 Days and 20.5 Hours
Abstract
BACKGROUND
Social determinants of health are social and economic factors that influence health intervention outcomes. Type 2 diabetes is a highly prevalent disease, primarily affecting individuals in low-to-middle-income countries. However, the association between social determinants and cardiovascular complications in type 2 diabetes has not been widely studied.
AIM
To examine the relationship between social determinants of health and cardiovascular complications in individuals with type 2 diabetes.
METHODS
We conducted a retrospective cohort study with an analytical component at a national-level referral hospital for military personnel in Bogota, Colombia. Patients treated at the diabetes clinic between September 2021 and December 2022 who met the inclusion criteria were included. A total of 583 patients participated in the study. We performed descriptive, bivariate, and binary logistic regression analyses, adjusting for confounding variables.
RESULTS
Among the 583 patients included, urban residency [odds ratio (OR) = 3.05, 95% confidence interval (CI): 1.01-9.20] and a middle or high educational level (OR = 2.33, 95%CI: 1.14-4.72) were associated with an increased risk of coronary artery disease. Additionally, receiving diabetes education beyond that provided by the clinic (OR = 2.15, 95%CI: 1.14-4.05) and lack of access to spaces for physical activity (OR = 4.05, 95%CI: 1.31-12.5) were associated with a higher risk of diabetic nephropathy and cerebrovascular disease, respectively.
CONCLUSION
Programs for diabetes management should account for social determinants of health that contribute to cardiovascular complications and increased healthcare costs. Population-based studies are needed to guide targeted interventions and clarify causal relationships.
Core Tip: Cardiac complications related to type 2 diabetes are affected by the condition of the patient and social determinants of health. These cardiovascular complications result in a lower quality of life and a more significant economic burden on health systems. Among the social determinants of health analyzed, urban residents and those with a middle or high educational level showed a higher risk of coronary artery disease. Receiving additional education beyond that provided by the diabetes clinic and individuals without the availability of spaces for physical activity showed a higher risk of developing diabetes nephropathy and cerebrovascular disease.
