Socioeconomic Position, Type 2 Diabetes and Long-Term Risk of Death

Else‐Marie Dalsgaard · Mette Vinther Skriver · Annelli Sandbæk · Mogens Vestergaard

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Health disparities and outcomes Diabetes Management and Research Diabetes, Cardiovascular Risks, and Lipoproteins

Abstract

BACKGROUND: Both socioeconomic position (SEP) and type 2 diabetes have previously been found to be associated with mortality; however, little is known about the association between SEP, type 2 diabetes and long-term mortality when comorbidity is taken into account. METHODS: We conducted a population-based cohort study of all Danish citizens aged 40-69 years with no history of diabetes during 2001-2006 (N=2,330,206). The cohort was identified using nationwide registers, and it was followed for up to 11 years (mean follow-up was 9.5 years (SD: 2.6)). We estimated the age-standardised mortality rate (MR) and performed Poisson regression to estimate the mortality-rate-ratio (MRR) by educational level, income and cohabiting status among people with and without type 2 diabetes. RESULTS: We followed 2,330,206 people for 22,971,026 person-years at risk and identified 139,681 individuals with type 2 diabetes. In total, 195,661 people died during the study period; 19,959 of these had type 2 diabetes. The age-standardised MR increased with decreasing SEP both for people with and without diabetes. Type 2 diabetes and SEP both had a strong impact on the overall mortality; the combined effect of type 2 diabetes and SEP on mortality was additive rather than multiplicative. Compared to women without diabetes and in the highest income quintile, the MRR's were 2.8 (95%CI 2.6, 3.0) higher for women with type 2 diabetes in the lowest income quintile, while diabetes alone increased the risk of mortality 2.0 (95%CI 1.9, 2.2) times and being in the lowest income quintile without diabetes 1.8 (95%CI 1.7,1.9) times after adjusting for comorbidity. For men, the MRR's were 2.7 (95%CI 2.5,2.9), 1.9 (95%CI 1.8,2.0) and 1.8 (95%CI 1.8,1.9), respectively. CONCLUSION: Both Type 2 diabetes and SEP were associated with the overall mortality. The relation between type 2 diabetes, SEP, and all-cause mortality was only partly explained by comorbidity.

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References

2003International Standard Classification of Education, ISCED 1997 2007Measuring socioeconomic position in health research 2006Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice 2004Socioeconomic Position and Health among Persons with Diabetes Mellitus: A Conceptual Framework and Review of the Literature 2008Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century 2012Lower educational level is a predictor of incident type 2 diabetes in European countries: The EPIC-InterAct study 2012Socioeconomic Status and Mortality 2013Socioeconomic inequalities in the incidence and prevalence of type 2 diabetes mellitus in Europe

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