Socioeconomic Status and Incident Type 2 Diabetes Mellitus: Data from the Women's Health Study

Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
PLoS ONE (Impact Factor: 3.23). 12/2011; 6(12):e27670. DOI: 10.1371/journal.pone.0027670
Source: PubMed


We prospectively examined whether socioeconomic status (SES) predicts incident type II diabetes (diabetes), a cardiovascular risk equivalent and burgeoning public health epidemic among women.
Participants include 23,992 women with Hb(A1c) levels <6% and no CVD or diabetes at baseline followed from February 1993 to March 2007. SES was measured by education and income while diabetes was self-reported.
Over 12.3 years of follow-up, 1,262 women developed diabetes. In age and race adjusted models, the relative risk of diabetes decreased with increasing education (<2 years of nursing, 2 to <4 years of nursing, bachelor's degree, master's degree, and doctorate: 1.0, 0.7 [95% Confidence Interval (CI), 0.6-0.8], 0.6 (95% CI, 0.5-0.7), 0.5 (95% CI, 0.4-0.6), 0.4 (95% CI, 0.3-0.5); p(trend)<0.001). Adjustment for traditional and non-traditional cardiovascular risk factors attenuated this relationship (education: p(trend) = 0.96). Similar associations were observed between income categories and diabetes.
Advanced education and increasing income were both inversely associated with incident diabetes even in this relatively well-educated cohort. This relationship was largely explained by behavioral factors, particularly body mass index.

Download full-text


Available from: Jessica M Peña, Jan 16, 2014
32 Reads
  • Source
    • "Lower SES levels may be associated with a higher risk of incident diabetes, especially amongst women [10-15]. Previous studies suggest that levels of Hgb A1c in persons without diabetes may increase as socio-economic deprivation worsens [2,11,16], leading to the hypothesis that stress associated with deprivation may have an effect on glycemic control [2]. Most published studies in this area have used surveys or data collected for randomized controlled trials done for other purposes [2,11,16]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Hgb A1c levels may be higher in persons without diabetes of lower socio-economic status (SES) but evidence about this association is limited; there is therefore uncertainty about the inclusion of SES in clinical decision support tools informing the provision and frequency of Hgb A1c tests to screen for diabetes. We studied the association between neighborhood-level SES and Hgb A1c in a primary care population without diabetes. This is a retrospective study using data routinely collected in the electronic medical records (EMRs) of forty six community-based family physicians in Toronto, Ontario. We analysed records from 4,870 patients without diabetes, age 45 and over, with at least one clinical encounter between January 1st 2009 and December 31st 2011 and one or more Hgb A1c report present in their chart during that time interval. Residential postal codes were used to assign neighborhood deprivation indices and income levels by quintiles. Covariates included elements known to be associated with an increase in the risk of incident diabetes: age, gender, family history of diabetes, body mass index, blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, and fasting blood glucose. The difference in mean Hgb A1c between highest and lowest income quintiles was -0.04% (p = 0.005, 95% CI -0.07% to -0.01%), and between least deprived and most deprived was -0.05% (p = 0.003, 95% CI -0.09% to -0.02%) for material deprivation and 0.02% (p = 0.2, 95% CI -0.06% to 0.01%) for social deprivation. After adjustment for covariates, a marginally statistically significant difference in Hgb A1c between highest and lowest SES quintile (p = 0.04) remained in the material deprivation model, but not in the other models. We found a small inverse relationship between Hgb A1c and the material aspects of SES; this was largely attenuated once we adjusted for diabetes risk factors, indicating that an independent contribution of SES to increasing Hgb A1c may be limited. This study does not support the inclusion of SES in clinical decision support tools that inform the use of Hgb A1c for diabetes screening.
    BMC Family Practice 01/2014; 15(1):7. DOI:10.1186/1471-2296-15-7 · 1.67 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Childhood socioeconomic status is linked to adult cardiovascular disease and disease risk. One proposed pathway involves inflammation due to exposure to a stress-inducing neighborhood environment. Whether CRP, a marker of systemic inflammation, is associated with stressful neighborhood conditions among children is unknown. The sample included 385 children 5-18 years of age from 255 households and 101 census tracts. Multilevel logistic regression analyses compared children and adolescents with CRP levels >3 mg/L to those with levels ≤3 mg/L across neighborhood environments. Among children living in neighborhoods (census tracts) in the upper tertile of poverty or crime, 18.6% had elevated CRP levels, in contrast to 7.9% of children living in neighborhoods with lower levels of poverty and crime. Children from neighborhoods with the highest levels of either crime or poverty had 2.7 (95% CI: 1.2-6.2) times the odds of having elevated CRP levels when compared to children from other neighborhoods, independent of adiposity, demographic and behavioral differences. Children living in neighborhoods with high levels of poverty or crime had elevated CRP levels compared to children from other neighborhoods. This result is consistent with a psychosocial pathway favoring early development of cardiovascular risk that involves chronic stress from exposure to socially- and physically-disordered neighborhoods characteristic of poverty.
    PLoS ONE 09/2012; 7(9):e45419. DOI:10.1371/journal.pone.0045419 · 3.23 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Conduct a longitudinal study, using hierarchical modeling, to evaluate the role of socioeconomic position at both the individual and the regional level regarding the disparities of preventable hospitalizations of diabetes patients in Taiwan. The database of the National Health Insurance was used in this study. All diabetes patients aged 18 and older who received regular care in 2000 were included in this study. The focus of this study was diabeticassociated preventable hospitalizations in 2001. Socioeconomic status was measured by income at the individual level and the regional level by the proportion of residents that had received a higher education. The control variables included age, gender, comorbidities, and the characteristics of the regular source of care where the patients received their care, including level (i.e. medical center, regional hospital, local hospital, outpatient clinic) and ownership (i.e. public or private-owned). The statistical analyses were performed using hierarchical generalized linear models. A total of 25 175 patients from 23 regions diagnosed with type-2 diabetes mellitus were indentified from the National Health Insurance claim data in 2000. From that total, 806 cases had at least one diabetic-related preventable hospitalization in 2001. This study found that a higher proportion of people with a higher education in a region, which corresponded with a higher individual income, was associated with a lower risk of diabetes-related preventable hospitalization (OR: 0.99 and 0.81). The results showed that both individual-level and regional-level socioeconomic status are important factors that are associated with the disparities in diabetes-related preventable hospitalizations.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
Show more