教育成就与 2 型糖尿病——老年人中是什么在介导两者之间的关系？来自 ESTHER 研究的数据：一项基于人群的队列研究。
Education achievement and type 2 diabetes-what mediates the relationship in older adults? Data from the ESTHER study: a population-based cohort study.
机构信息
UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
Centre for Statistical Science and Operational Research (CenSSOR), Queen's University Belfast, Belfast, UK.
出版信息
BMJ Open. 2017 Apr 17;7(4):e013569. doi: 10.1136/bmjopen-2016-013569.
OBJECTIVE
The study aims to identify the mediating factors of the relationship between education achievement and incident type 2 diabetes mellitus (T2DM) in older adults.
DESIGN
Population-based cohort study.
SETTING
Participants were recruited from the German federal state of Saarland.
PARTICIPANTS
Participants were excluded if they had prevalent T2DM or missing data on prevalent T2DM, missing or zero follow-up time for incident T2DM or were under 50 years of age. The total sample consisted of 7462 individuals aged 50-75 years (42.8% men, mean age 61.7 years) at baseline (2000-02). The median follow-up time was 8.0 years.
METHODS
Cox proportional hazards regression was initially used to determine the direct association between education achievement and incident T2DM. Using the Baron and Kenny approach, we then investigated the associations between education achievement and incident T2DM with the potential mediators. The contribution of each of the putative mediating variables was then calculated.
RESULTS
A clear socioeconomic gradient was observed with regard to T2DM incidence with the lowest educated individuals at a greater risk of developing the disease during the follow-up period: HR (95% CI) high education: 0.52 (0.34 to 0.80); medium education: 0.80 (0.66 to 0.96). Seven of the variables considered explained a proportion of the education-T2DM relationship (body mass index, alcohol consumption, hypertension, fasting triglycerides, high-density lipoprotein (HDL) cholesterol, physical activity and smoking status), where the contribution of the variables ranged from 1.0% to 17.7%. Overall, the mediators explained 31.7% of the relationship.
CONCLUSION
By identifying the possible mediating factors of the relationship between education achievement and incident T2DM in older adults, the results of this study can be used to assist with the development of public health strategies that aim to reduce socioeconomic inequalities in T2DM.
目的
本研究旨在确定教育成就与老年人 2 型糖尿病（T2DM）发病风险之间关系的中介因素。
设计
基于人群的队列研究。
地点
参与者来自德国萨尔州。
参与者
如果存在以下情况则排除在外：既往患有 T2DM 或既往 T2DM 数据缺失、缺失或无 T2DM 发病后随访时间或年龄小于 50 岁。总样本包括 7462 名年龄在 50-75 岁（男性占 42.8%，平均年龄 61.7 岁）的个体，他们在基线（2000-02 年）时无 T2DM。中位随访时间为 8.0 年。
方法
首先，使用 Cox 比例风险回归来确定教育成就与 T2DM 发病之间的直接关联。然后，使用 Baron 和 Kenny 方法，我们研究了教育成就与 T2DM 发病之间的关联，以及潜在的中介因素。然后计算每个假定的中介变量的贡献。
结果
在 T2DM 发病方面，我们观察到了明显的社会经济梯度，受教育程度最低的个体在随访期间发生疾病的风险更高：HR（95%CI）高教育：0.52（0.34 至 0.80）；中等教育：0.80（0.66 至 0.96）。考虑到的七个变量解释了教育与 T2DM 之间关系的一部分（体重指数、饮酒、高血压、空腹甘油三酯、高密度脂蛋白胆固醇、身体活动和吸烟状况），这些变量的贡献范围为 1.0%至 17.7%。总体而言，中介变量解释了 31.7%的关系。
结论
通过确定老年人教育成就与 T2DM 发病之间关系的可能中介因素，本研究结果可用于协助制定公共卫生策略，以减少 T2DM 方面的社会经济不平等。
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