Sahlgrenska University Hospital, Gothenburg, Sweden Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden National Diabetes Register, Centre of Registers, Gothenburg, Sweden.
Diabetes Care. 2015 Aug;38(8):1518-27. doi: 10.2337/dc15-0145. Epub 2015 May 13.
Socioeconomic status (SES) is a powerful predictor of cardiovascular disease (CVD) and death. We examined the association in a large cohort of patients with type 1 diabetes.
Clinical data from the Swedish National Diabetes Register were linked to national registers, whereby information on income, education, marital status, country of birth, comorbidities, and events was obtained. Patients were followed until a first incident event, death, or end of follow-up. The association between socioeconomic variables and the outcomes was modeled using Cox regression, with rigorous covariate adjustment.
We included 24,947 patients. Mean (SD) age and follow-up was 39.1 (13.9) and 6.0 (1.0) years. Death and fatal/nonfatal CVD occurred in 926 and 1378 individuals. Compared with being single, being married was associated with 50% lower risk of death, cardiovascular (CV) death, and diabetes-related death. Individuals in the two lowest quintiles had twice as great a risk of fatal/nonfatal CVD, coronary heart disease, and stroke and roughly three times as great a risk of death, diabetes-related death, and CV death as individuals in the highest income quintile. Compared with having ≤9 years of education, individuals with a college/university degree had 33% lower risk of fatal/nonfatal stroke. Immigrants had 19%, 33%, and 45% lower risk of fatal/nonfatal CVD, all-cause death, and diabetes-related death, respectively, compared with Swedes. Men had 44%, 63%, and 29% greater risk of all-cause death, CV death, and diabetes-related death.
Low SES increases the risk of CVD and death by a factor of 2-3 in type 1 diabetes.
社会经济地位（SES）是心血管疾病（CVD）和死亡的强有力预测因素。我们在大量 1 型糖尿病患者中研究了这种关联。
从瑞典国家糖尿病登记处获得临床数据，并与国家登记处相关联，从而获得收入、教育、婚姻状况、出生地、合并症和事件的信息。患者随访至首次发生事件、死亡或随访结束。使用 Cox 回归模型，通过严格的协变量调整，对社会经济变量与结局之间的关系进行建模。
我们纳入了 24947 名患者。平均（SD）年龄和随访时间分别为 39.1（13.9）岁和 6.0（1.0）年。926 例和 1378 例患者发生死亡和致死性/非致死性 CVD。与单身相比，已婚与死亡、心血管（CV）死亡和糖尿病相关死亡的风险降低 50%相关。处于收入最低的两个五分位数的个体发生致死性/非致死性 CVD、冠心病和中风的风险增加一倍，死亡、糖尿病相关死亡和 CV 死亡的风险增加近三倍，而处于收入最高五分位数的个体则为两倍。与受教育年限≤9 年相比，具有大学/大学学位的个体发生致死性/非致死性中风的风险降低 33%。与瑞典人相比，移民发生致死性/非致死性 CVD、全因死亡和糖尿病相关死亡的风险分别降低 19%、33%和 45%。男性全因死亡、CV 死亡和糖尿病相关死亡的风险分别增加 44%、63%和 29%。
在 1 型糖尿病中，低 SES 使 CVD 和死亡的风险增加 2-3 倍。
