Glover LáShauntá M, Martin Chantel L, Green-Howard Annie, Adatorwovor Reuben, Loehr Laura, Staley-Salil Brooke, North Kari E, Sims Mario
Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
SSM Popul Health. 2023 Mar 28;22:101389. doi: 10.1016/j.ssmph.2023.101389. eCollection 2023 Jun.
The cumulative socioeconomic status (SES) model posits that childhood and adult experiences accumulate to influence disease risk. While individual SES indicators such as education and income are independently associated with incident type 2 diabetes (T2D), the association of cumulative SES and incident T2D is unclear, especially in African American adults.
We utilized cohort data of African American participants (n = 3681, mean age 52.6 years) enrolled in the Jackson Heart Study from 2000 to 2013 free of T2D or cardiovascular disease at baseline (2000-2004). Cumulative SES scores at baseline were derived using six SES indicators (education, wealth, income, occupation, employment status, and mother's education) categorized as low, middle, and high. Incident T2D was defined at exam 2 (2005-2008) or exam 3 (2009-2013) based on fasting glucose ≥126 mg/dL, HbA1c ≥ 6.5, reported diabetic medication use, or self-reported physician diagnosis. Proportional hazards regression, allowing for interval censoring, was used to estimate the association between cumulative SES and incident T2D (hazard ratio(HR), 95% confidence interval (CI)) after adjustment for covariates. Sex and age differences were tested using interaction terms.
There were 544 incident T2D cases. The association between low (versus high) cumulative SES and incident T2D was not significant (HR 1.04 [95% CI 0.85, 1.28]) and did not differ by sex (>0.05). However, there were differences by (age p value for interaction = 0.0052 for middle-aged adults and 0.0186 for older adults). Low (versus high) cumulative SES was associated a greater hazard of incident T2D among those 20-46 years (HR 1.12 [95% CI 1.03, 1.21]), 47-59 years (HR 1.25 [95% CI 1.06, 1.47]) and those 60-93 years (HR 1.39 [95% CI 1.09, 1.78]) after adjustment for sex and family history of diabetes. Associations attenuated after adding behavioral and lifestyle risk factors.
The association of low cumulative SES and incident T2D differed by age, which may suggest interventionist should consider impacts of SES on T2D by age.
累积社会经济地位（SES）模型认为，儿童期和成年期经历会累积起来影响疾病风险。虽然诸如教育程度和收入等个体SES指标与2型糖尿病（T2D）发病独立相关，但累积SES与T2D发病之间的关联尚不清楚，尤其是在非裔美国成年人中。
我们利用了参加杰克逊心脏研究的非裔美国参与者（n = 3681，平均年龄52.6岁）的队列数据，这些参与者在基线期（2000 - 2004年）无T2D或心血管疾病。基线期的累积SES分数是使用六个SES指标（教育程度、财富、收入、职业、就业状况和母亲的教育程度）得出的，这些指标分为低、中、高三个类别。根据空腹血糖≥126 mg/dL、糖化血红蛋白≥6.5、报告使用糖尿病药物或自我报告的医生诊断，在第2次检查（2005 - 2008年）或第3次检查（2009 - 2013年）时定义T2D发病。在对协变量进行调整后，使用允许区间删失的比例风险回归来估计累积SES与T2D发病之间的关联（风险比（HR），95%置信区间（CI））。使用交互项检验性别和年龄差异。
有544例T2D发病病例。低（相对于高）累积SES与T2D发病之间的关联不显著（HR 1.04 [95% CI 0.85, 1.28]），且在性别上无差异（>0.05）。然而，存在年龄差异（中年成年人的交互作用p值 = 0.0052，老年人的交互作用p值 = 0.0186）。在对性别和糖尿病家族史进行调整后，低（相对于高）累积SES与20 - 46岁人群（HR 1.12 [95% CI 1.03, 1.21]）、47 - 59岁人群（HR 1.25 [95% CI 1.06, 1.47]）以及60 - 93岁人群（HR 1.39 [95% CI 1.09, 1.78]）的T2D发病风险增加相关。在加入行为和生活方式风险因素后，关联减弱。
低累积SES与T2D发病之间的关联因年龄而异，这可能表明干预者应考虑SES按年龄对T2D的影响。
