Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, China.
Department of Sociology, University at Albany, State University of New York, Albany, CA, United States.
Front Public Health. 2023 Aug 22;11:1197947. doi: 10.3389/fpubh.2023.1197947. eCollection 2023.
Diabetes disproportionately affects minorities and those with low socioeconomic status (SES) in the United States, and differences in behavioral lifestyles are largely responsible for the unequal distribution of diabetes among different groups.
With data of 9,969 participants collected in the 2007-2008 and 2009-2010 cycles of the US National Health and Nutrition Examination Survey (NHANES), this study examined several mediators and their mediating effects in the connection between SES and the risk of diabetes. The SES is assessed by the income-to-poverty ratio (IPR), education level, and employment status. For the mediation analysis, we used health-related behaviors as mediators (smoking, alcohol use, consumption of green vegetables and fruits, physical activity and sedentary time, health insurance, and healthcare). In this study, the structural equation model was utilized to evaluate the mediating effects of behavioral lifestyle as a mediator in the relationship between SES and diabetes.
A total of 9,969 participants were included in this study. We found a negative nonlinear association between IPR and diabetes risk ( < 0.001; = 0.46), which was independent of the majority of known or suspected risk factors and confounding variables (gender, age, race). Participants with lower SES had higher risk of diabetes compared with those with higher SES. In mediating analysis, we found alcohol intake (OR = 0.996), physical activity (OR = 0.993), health insurance (OR = 0.998), and healthcare (OR = 1.002) mediated the IPR-diabetes association. But in the relationship between education status and diabetes, the mediation effect of alcohol intake (OR = 0.995), physical activity (OR = 0.991), and health care (OR = 1.008) were obvious. Likewise, alcohol intake (OR = 0.996), fruit intake (OR = 0.998), and health care (OR = 0.975) were important mediators in the association between employment status and diabetes.
This study provides critical insights on the link between SES and diabetes. Our results highlight that poor health-related behaviors and limited access to healthcare are important pathways for increased diabetes risk related to those with low SES, particularly among Mexican Americans and males. They should be top priorities for agencies and healthcare providers to develop behavior-related interventions to reduce inequalities in diabetes risk.
在美国，糖尿病在少数民族和社会经济地位较低的人群中发病率较高，而行为生活方式的差异是导致不同人群糖尿病分布不均的主要原因。
本研究利用美国国家健康和营养调查（NHANES）2007-2008 年和 2009-2010 年周期中 9969 名参与者的数据，研究了几种中介因素及其在 SES 与糖尿病风险之间的中介效应。SES 由收入贫困比（IPR）、教育水平和就业状况来评估。对于中介分析，我们将健康相关行为作为中介因素（吸烟、饮酒、绿色蔬菜和水果摄入、体力活动和久坐时间、健康保险和医疗保健）。在本研究中，我们使用结构方程模型来评估行为生活方式作为 SES 和糖尿病之间关系的中介因素的中介效应。
本研究共纳入 9969 名参与者。我们发现，IPR 与糖尿病风险之间呈负非线性关系（ < 0.001； = 0.46），这种关系独立于大多数已知或可疑的风险因素和混杂变量（性别、年龄、种族）。SES 较低的参与者比 SES 较高的参与者患糖尿病的风险更高。在中介分析中，我们发现饮酒（OR=0.996）、体力活动（OR=0.993）、健康保险（OR=0.998）和医疗保健（OR=1.002）中介了 IPR 与糖尿病的关系。但在教育程度与糖尿病的关系中，饮酒（OR=0.995）、体力活动（OR=0.991）和医疗保健（OR=1.008）的中介作用明显。同样，饮酒（OR=0.996）、水果摄入（OR=0.998）和医疗保健（OR=0.975）是就业状况与糖尿病之间关联的重要中介因素。
本研究为 SES 与糖尿病之间的关系提供了重要的见解。我们的研究结果强调，不良的健康相关行为和有限的医疗保健机会是导致 SES 较低人群糖尿病风险增加的重要途径，特别是在墨西哥裔美国人和男性中。对于各机构和医疗保健提供者来说，应将这些因素作为优先事项，制定与行为相关的干预措施，以减少糖尿病风险方面的不平等。
