School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 89 Commercial Road, Melbourne, Victoria 3004, Australia.
Diabetologia. 2010 Dec;53(12):2538-45. doi: 10.1007/s00125-010-1888-4. Epub 2010 Aug 26.
AIMS/HYPOTHESIS: To identify the impact of socioeconomic status on incident impaired glucose metabolism and type 2 diabetes and to investigate the mediating role of health behaviours on this relationship using national, population-based data.
The Australian Diabetes Obesity and Lifestyle (AusDiab) Study is a national, population-based, longitudinal study of adults aged 25 years and above. A total sample of 4,405 people provided complete baseline (1999-2000) and 5 year follow-up (2004-2005) data relevant for these analyses. Fasting plasma glucose and 2 h plasma glucose were obtained from an OGTT, and demographic, socioeconomic and behavioural data were collected by interview and questionnaire. Multinomial logistic regression examined the role of socioeconomic position in the development of diabetes and mediation analyses tested the contribution of health behaviours in this relationship.
Highest level of education was a stronger predictor of incident impaired glucose tolerance and type 2 diabetes (p = 0.002), compared with household income (p = 0.103), and occupational grade (p = 0.202). Education remained a significant independent predictor of diabetes in fully adjusted models. However, the relationship was attenuated by the health behaviours (smoking and physical activity). Mediation analyses indicated that these behaviours were partial mediators (explaining 27%) of the socioeconomic status-diabetes relationship.
CONCLUSION/INTERPRETATION: Smoking and physical activity partly mediate the relationship between low education and type 2 diabetes. Identification of these modifiable behavioural mediators should facilitate the development of effective health promotion campaigns to target those at high risk of developing type 2 diabetes.
目的/假设：本研究旨在利用全国性的人口数据，确定社会经济地位对葡萄糖代谢受损和 2 型糖尿病发病的影响，并探讨健康行为在这一关系中的中介作用。
澳大利亚糖尿病肥胖与生活方式研究（AusDiab）是一项全国性、基于人群的、对 25 岁及以上成年人进行的纵向研究。共有 4405 名参与者提供了完整的基线（1999-2000 年）和 5 年随访（2004-2005 年）数据，这些数据与本研究相关。通过口服葡萄糖耐量试验（OGTT）获取空腹血浆葡萄糖和 2 小时血浆葡萄糖，通过访谈和问卷调查收集人口统计学、社会经济和行为数据。采用多项逻辑回归检验社会经济地位在糖尿病发病中的作用，采用中介分析检验健康行为在这一关系中的作用。
与家庭收入（p = 0.103）和职业等级（p = 0.202）相比，最高教育水平是葡萄糖耐量受损和 2 型糖尿病发病的更强预测因素（p = 0.002）。在完全调整的模型中，教育仍然是糖尿病的独立预测因素。然而，健康行为（吸烟和体力活动）削弱了这种关系。中介分析表明，这些行为是社会经济地位与糖尿病关系的部分中介因素（解释了 27%）。
结论/解释：吸烟和体力活动部分解释了低教育水平与 2 型糖尿病之间的关系。识别这些可改变的行为中介因素，有助于制定针对那些有患 2 型糖尿病高风险人群的有效健康促进活动。
