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
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".