Camelo Lidyane V, Giatti Luana, Duncan Bruce B, Chor Dóra, Griep Rosane Härter, Schmidt Maria Inês, Barreto Sandhi Maria
Postgraduate Program in Public Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Postgraduate Program in Epidemiology and Hospital de Clinicas de Porto Alegre, Universidade Federal Rio Grande do Sul, Porto Alegre, Brazil.
Ann Epidemiol. 2016 Dec;26(12):858-864.e1. doi: 10.1016/j.annepidem.2016.09.014. Epub 2016 Oct 8.
We investigated gender-specific associations of cumulative socioeconomic position across life course and social mobility with new onset diabetes mellitus (NODM) in over 12,000 civil servants in Brazil.
We used data from ELSA-Brasil baseline (2008-2010). The accumulation of risk was assessed using an education-based score and an occupation-based score. Educational and occupational social mobility were also evaluated.
In minimally adjusted models, NODM increased with increasing exposure to life-course social disadvantages, especially in men. This gender difference was pronounced when cumulative processes were evaluated by education-based scores (high vs. low cumulative social disadvantage, odds ratio [OR] = 4.7; 95% confidence interval [CI]: 2.6-8.5 in men and OR = 2.0; 95% CI: 1.1-3.6 in women). After including proximal diabetes risk factors possibly acting as mediators, these associations remained high only in men (high vs. low cumulative social disadvantage, OR = 4.4; 95% CI: 2.4-8.1). Social mobility was associated with NODM in men. Compared to the high-stable trajectory, downward had greater associations than upward mobility. In women, when considering metabolic syndrome-related variables, changes in social hierarchy did not seem to have an influence on their risk of diabetes.
Accumulation of risk and social mobility were associated with NODM with gender-specific patterns, suggesting differences in mechanisms connecting life-course socioeconomic position and diabetes in men and women.
我们在巴西12000多名公务员中，调查了生命历程中累积社会经济地位和社会流动性与新发糖尿病（NODM）之间的性别特异性关联。
我们使用了巴西老年健康与退休纵向研究（ELSA-Brasil）基线（2008 - 2010年）的数据。使用基于教育程度的评分和基于职业的评分来评估风险累积情况。还评估了教育和职业社会流动性。
在最小调整模型中，NODM随着生命历程中社会劣势暴露的增加而增加，尤其是在男性中。当通过基于教育程度的评分评估累积过程时，这种性别差异很明显（高累积社会劣势与低累积社会劣势相比，男性的优势比[OR] = 4.7；95%置信区间[CI]：2.6 - 8.5，女性的OR = 2.0；95% CI：1.1 - 3.6）。纳入可能作为中介因素的近端糖尿病危险因素后，这些关联仅在男性中仍然很高（高累积社会劣势与低累积社会劣势相比，OR = 4.4；95% CI：2.4 - 8.1）。社会流动性与男性的NODM相关。与高稳定轨迹相比，向下流动的关联性大于向上流动。在女性中，当考虑与代谢综合征相关的变量时，社会阶层的变化似乎对她们患糖尿病的风险没有影响。
风险累积和社会流动性与NODM存在性别特异性模式的关联，这表明男性和女性在连接生命历程社会经济地位和糖尿病的机制上存在差异。
