Socioeconomic Disparities in Insulin Resistance: Results From the Princeton School District Study

Department of Pediatrics, Tufts-New England Medical Center and Tufts University School of Medicine, Boston, MA 02111, USA.
Psychosomatic Medicine (Impact Factor: 3.47). 02/2007; 69(1):61-7. DOI: 10.1097/01.psy.0000249732.96753.8f
Source: PubMed


The objectives of this study were to determine whether lower socioeconomic status (SES) is associated with changes in insulin resistance in adolescents over a 3-year period and explore moderators of this effect.
A total of 1167 healthy non-Hispanic black and white participants in the Princeton School District Study, a longitudinal study of fifth to 12th graders in a suburban Midwestern public school district were included in this study. Inclusion criteria were a) physical examination and fasting morning blood draw at baseline and 3 years later, b) younger than 20 years old at follow up, and c) information available on SES provided by a parent. The influence of SES on insulin resistance and change in insulin resistance over time was examined using general linear models adjusting for multiple covariates. Models also assessed if race or baseline weight status changed the SES-insulin resistance relationship and explored the role of perceived stress.
Blacks and lower SES youth had higher body mass index z score and increased insulin resistance (p < .001). In multivariable models, lower parent education, but not household income, was associated with higher baseline insulin resistance (F = 7.84, p < .001) and worsening insulin resistance over time (F = 18.86, p < .001). Parent education's effect on change in insulin resistance was more pronounced for obese youth compared with nonobese (F interaction = 10.12, p < .001) even with adjustment for multiple covariates. Perceived stress did not alter these relationships.
Lower parent education appears to be related to increased insulin resistance both cross-sectionally and over time in black and white adolescents. Worsening insulin resistance is especially problematic for obese adolescents from families with low parent education.

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Available from: Elizabeth Goodman, Jan 07, 2014
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    • "In a Danish study, there was a positive association between CVD in adulthood and an increasing body mass index (BMI) in childhood [4]. In addition, children with a higher BMI were more likely to have insulin resistance [5]. Children with insulin resistance, in turn, are very likely to develop type 2 diabetes and an adverse lipid profile [6,7]. "
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    ABSTRACT: Background Socioeconomic inequalities in cardiovascular disease are pervasive, yet much remains to be understood about how they originate. The objective of this study was to explore the relations of socioeconomic status to lipid and glucose metabolism as indicators of cardiovascular health in 5–6 year olds. Additionally to explore the explanatory role of maternal factors, birth outcome, and child factors. Methods In 1308 5–6 year old ethnic Dutch children from the ABCD cohort study, lipids (cholesterol, LDL, HDL, triglycerides), glucose and C-peptide were measured after an overnight-fast. Results There were no differences in cholesterol, HDL, LDL, and triglycerides between socioeconomic groups, as indicated by maternal education and income adequacy. However, children of low educated mothers had on average a higher glucose (β = 0.15; 95% confidence interval (CI) 0.03 – 0.27), logC-peptide (β = 0.07; 95% CI 0.04 – 0.09), and calculated insulin resistance (HOMA-IR) (β = 0.15; 95% CI 0.08 – 0.22) compared to children of high educated mothers. Only childhood BMI partly explained these differences (models controlled for age, height, and sex). Conclusions The socioeconomic gradient in cardiovascular risk factors seems to emerge in early childhood. In absence of underlying mechanisms these empirical findings are relevant for public health care and further explanatory research.
    Full-text · Article · Aug 2012 · BMC Public Health
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    • "Data were from the Princeton School District Study, details of which can be found elsewhere (Dolan et al., 2005; Goodman, Daniels, & Dolan, 2007; Goodman, McEwen, Dolan, Schafer-Kalkhoff, & Adler, 2005; Goodman, McEwen, Huang, Dolan, & Adler, 2005). The Midwestern school district from which participants were sampled " is a welldefined , racially integrated (African American, Non-Hispanic [W]hite), urban-suburban school district with a wide range of socioeconomic status in each ethnic group " (Dolan et al., 2005, p. 752). "
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    ABSTRACT: Some markers of social disadvantage are associated robustly with depressive symptoms among adolescents: female gender and lower socioeconomic status (SES), respectively. Others are associated equivocally, notably Black v. White race/ethnicity. Few studies examine whether markers of social disadvantage by gender, SES, and race/ethnicity jointly predict self-reported depressive symptoms during adolescence; this was our goal. Secondary analyses were conducted on data from a socioeconomically diverse community-based cohort study of non-Hispanic Black and White adolescents (N = 1,263, 50.4% female). Multivariable general linear models tested if female gender, Black race/ethnicity, and lower SES (assessed by parent education and household income), and their interactions predicted greater depressive symptoms reported on the Center for Epidemiological Studies-Depression scale. Models adjusted for age and pubertal status. Univariate analyses revealed more depressive symptoms in females, Blacks, and participants with lower SES. Multivariable models showed females across both racial/ethnic groups reported greater depressive symptoms; Blacks demonstrated more depressive symptoms than did Whites but when SES was included this association disappeared. Exploratory analyses suggested Blacks gained less mental health benefit from increased SES. However there were no statistically significant interactions among gender, race/ethnicity, or SES. Taken together, we conclude that complex patterning among low social status domains within gender, race/ethnicity, and SES predicts depressive symptoms among adolescents.
    Full-text · Article · Jul 2011 · Race and Social Problems
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    • "HbA1c levels above 5.8% and 6.0% were used in two studies to define metabolically abnormal cases [47,48]. Insulin resistance according to HOMA-IR levels above 5.8 and 6.0 was the outcome parameter in two more studies [46,50]. One study defined "metabolically normal" cases following the definition of metabolic syndrome from the International Diabetes Federation, but without weight indicators because only participants with BMI ≥ 25 kg/m2 were included [49]. "
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    ABSTRACT: Psychological factors and socioeconomic status (SES) have a notable impact on health disparities, including type 2 diabetes risk. However, the link between childhood psychosocial factors, such as childhood adversities or parental SES, and metabolic disturbances is less well established. In addition, the lifetime perspective including adult socioeconomic factors remains of further interest.We carried out a systematic review with the main question if there is evidence in population- or community-based studies that childhood adversities (like neglect, traumata and deprivation) have considerable impact on type 2 diabetes incidence and other metabolic disturbances. Also, parental SES was included in the search as risk factor for both, diabetes and adverse childhood experiences. Finally, we assumed that obesity might be a mediator for the association of childhood adversities with diabetes incidence. Therefore, we carried out a second review on obesity, applying a similar search strategy. Two systematic reviews were carried out. Longitudinal, population- or community-based studies were included if they contained data on psychosocial factors in childhood and either diabetes incidence or obesity risk. We included ten studies comprising a total of 200,381 individuals. Eight out of ten studies indicated that low parental status was associated with type 2 diabetes incidence or the development of metabolic abnormalities. Adjustment for adult SES and obesity tended to attenuate the childhood SES-attributable risk but the association remained. For obesity, eleven studies were included with a total sample size of 70,420 participants. Four out of eleven studies observed an independent association of low childhood SES on the risk for overweight and obesity later in life. Taken together, there is evidence that childhood SES is associated with type 2 diabetes and obesity in later life. The database on the role of psychological factors such as traumata and childhood adversities for the future risk of type 2 diabetes or obesity is too small to draw conclusions. Thus, more population-based longitudinal studies and international standards to assess psychosocial factors are needed to clarify the mechanisms leading to the observed health disparities.
    Full-text · Article · Sep 2010 · BMC Public Health
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