Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, GA, USA.
Diabetes Care. 2013 Jan;36(1):49-55. doi: 10.2337/dc11-1864. Epub 2012 Aug 28.
Although several studies have examined the association between socioeconomic status (SES) and mortality in the general population, few have investigated this relationship among people with diabetes. This study sought to determine how risk of mortality associated with measures of SES among adults with diagnosed diabetes is mitigated by association with demographics, comorbidities, diabetes treatment, psychological distress, or health care access and utilization.
The study included 6,177 adults aged 25 years or older with diagnosed diabetes who participated in the National Health Interview Surveys (1997-2003) linked to mortality data (follow-up through 2006). SES was measured by education attained, financial wealth (either stocks/dividends or home ownership), and income-to-poverty ratio.
In unadjusted analysis, risk of death was significantly greater for people with lower levels of education and income-to-poverty ratio than for those at the highest levels. After adjusting for demographics, comorbidities, diabetes treatment and duration, health care access, and psychological distress variables, the association with greater risk of death remained significant only for people with the lowest level of education (relative hazard 1.52 [95% CI 1.04-2.23]). After multivariate adjustment, the risk of death was significantly greater for people without certain measures of financial wealth (e.g., stocks, home ownership) (1.56 [1.07-2.27]) than for those with them.
The findings suggest that after adjustments for demographics, health care access, and psychological distress, the level of education attained and financial wealth remain strong predictors of mortality risk among adults with diabetes.
尽管已有多项研究探讨了社会经济地位（SES）与一般人群死亡率之间的关系，但很少有研究调查糖尿病患者的这种关系。本研究旨在确定在患有确诊糖尿病的成年人中，SES 与死亡率之间的关联如何通过与人口统计学、合并症、糖尿病治疗、心理困扰或医疗保健的获得和利用相关联而减轻。
该研究纳入了 6177 名年龄在 25 岁及以上的患有确诊糖尿病的成年人，他们参加了国家健康访谈调查（1997-2003 年），并与死亡率数据（随访至 2006 年）相关联。SES 通过受教育程度、财务财富（股票/股息或房屋所有权）和收入与贫困比率来衡量。
在未调整的分析中，与受教育程度和收入与贫困比率最低的人相比，教育程度和收入与贫困比率较低的人的死亡风险显著更高。在调整了人口统计学、合并症、糖尿病治疗和持续时间、医疗保健的获得和心理困扰变量后，与死亡风险增加的关联仅在受教育程度最低的人群中仍然显著（相对危险度 1.52[95%CI 1.04-2.23]）。经过多变量调整后，与没有一定程度的财务财富（如股票、房屋所有权）的人相比，死亡风险显著更高（1.56[1.07-2.27]）。
这些发现表明，在调整了人口统计学、医疗保健的获得和心理困扰后，受教育程度和财务财富仍然是糖尿病成年人死亡率风险的强有力预测因素。
