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

Objective: Socioeconomic resources and family support have been shown to improve adherence to treatment in people with type 2 diabetes (T2D) and are 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. Methods: We included 74,588 adults who were at least 65 years of age at the time of T2D diagnosis over the period of 2000 to 2018 in Denmark and grouped them based on having children (yes [reference]/no), and their children's highest educational level (low/medium/high [reference]). Multistate models were performed with 3 states: T2D diagnosis, diabetes-related complication, and death. All models were stratified by other chronic diseases at baseline (yes/no). Results: During follow-up (mean, 5.5 years), 14.6% of the adults 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 (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.17 to 1.33) and with (HR, 1.10; 95% CI, 1.02 to 1.18) other chronic diseases and after complication among adults without other chronic diseases (HR, 1.25; 95% CI, 1.12 to 1.38). Having children with a lower educational level was associated with higher hazard of complication (HR_low, 1.14; 95% CI, 1.05 to 1.24; HR_medium, 1.11; 95% CI, 1.05 to 1.17), death without complication (HR_low, 1.26; 95% CI, 1.17 to 1.36; HR_medium, 1.07; 95% CI, 1.02 to 1.14) and after complication (HR_low, 1.22; 95% CI, 1.07 to 1.39) among adults without other chronic diseases. Conclusions: Among adults without other chronic diseases, having no children or having children with lower educational levels was associated with a higher hazard of death. Among these adults, having children with lower educational levels was also associated with a higher hazard of diabetes-related complication.