Ko G T, Chan J C, Yeung V T, Chow C C, Tsang L W, Cockram C S
Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, NT, PR China.
Eur J Epidemiol. 2001;17(3):289-95. doi: 10.1023/a:1017935707807.
To examine whether a low socio-economic status (SES) is an additional risk factor for glucose intolerance in Hong Kong Chinese with known risk factors for glucose intolerance, a total of 2847 Chinese subjects (473 men and 2374 women) were recruited from the community for assessment. They had known risk factors for glucose intolerance including a previous history of gestational diabetes, positive family history of diabetes in first degree relatives and equivocal fasting plasma glucose concentrations between 7 and 8 mmol/l or random plasma glucose concentrations between 8 and 11 mmol/l. The 2847 subjects were classified according to their education levels and occupations: education group 1 = high school or university, group 2 = middle school, group 3 = illiterate or up to elementary school; occupational group 1 = professional or managerial, group 2 = non-manual, group 3 = manual, group 4 = unskilled, group 5 = housewife or unemployed. Different socio-economic groups were well represented in this selected population. The distribution of educational groups in this study was similar to that recorded in the 1991 Hong Kong Census. When analysed according to education levels and after adjustment for age, women in the lowest social class had the highest prevalence of diabetes, body mass index, blood pressure and plasma glucose concentrations. Men with the lowest education level had the highest prevalence of diabetes after age adjustment. The age-adjusted odds ratio (95% confidence intervals) of having diabetes was 2.3 (1.3. 4.3) in female subjects and 2.5 (1.2, 5.4) in male subjects with the lowest SES compared to subjects with the highest SES. When categorised according to occupation and after adjustment for age, women in the lowest social class had the highest prevalence of diabetes and glycaemic indexes. The age-adjusted odds ratio of having diabetes was 4.5 (1.9, 10.9) in female subjects with the lowest SES compared to those with the highest SES. The corresponding age-adjusted odds ratio in male subjects was 1.9 (0.9, 3.9) but this was not statistically significant. In conclusion, a lower socio-economic class, categorised either by occupational or educational level, was an additional risk factor for diabetes in Hong Kong Chinese who had known risk factors for glucose intolerance. These subjects should have increased priority for health education and regular diabetes screening. Our findings further emphasise the complex relationships between societal affluence, personal income and educational level.
为了研究低社会经济地位（SES）是否是香港已知糖耐量异常风险因素的中国人糖耐量异常的额外风险因素，我们从社区招募了2847名中国受试者（473名男性和2374名女性）进行评估。他们有已知的糖耐量异常风险因素，包括既往妊娠糖尿病史、一级亲属糖尿病家族史阳性以及空腹血糖浓度在7至8mmol/l之间或随机血糖浓度在8至11mmol/l之间不明确。这2847名受试者根据其教育水平和职业进行分类：教育组1 = 高中或大学学历，组2 = 中学学历，组3 = 文盲或小学及以下学历；职业组1 = 专业或管理职业，组2 = 非体力职业，组3 = 体力职业，组4 = 无技能职业，组5 = 家庭主妇或失业者。不同社会经济群体在这个选定人群中都有很好的代表性。本研究中教育组的分布与1991年香港人口普查记录的相似。根据教育水平分析并调整年龄后，社会阶层最低的女性糖尿病、体重指数、血压和血糖浓度的患病率最高。年龄调整后，教育水平最低的男性糖尿病患病率最高。与社会经济地位最高的受试者相比，社会经济地位最低的女性受试者患糖尿病的年龄调整比值比（95%置信区间）为2.3（1.3，4.3），男性受试者为2.5（1.2，5.4）。根据职业分类并调整年龄后，社会阶层最低的女性糖尿病和血糖指数患病率最高。与社会经济地位最高的女性受试者相比，社会经济地位最低的女性受试者患糖尿病的年龄调整比值比为4.5（1.9，10.9）。男性受试者相应的年龄调整比值比为1.9（0.9，3.9），但无统计学意义。总之，无论是按职业还是教育水平分类，较低的社会经济阶层都是香港已知糖耐量异常风险因素的中国人患糖尿病的额外风险因素。这些受试者应优先接受健康教育和定期糖尿病筛查。我们的研究结果进一步强调了社会富裕程度、个人收入和教育水平之间的复杂关系。
