Huang Yikeng, Zheng Zhi, Chen Haibing, Gu Chufeng
Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Eye Diseases; Shanghai Clinical Research Center for Eye Diseases; Shanghai Key Clinical Specialty; Shanghai Key Laboratory of Ocular Fundus Diseases; Shanghai Engineering Center for Visual Science and Photomedicine; Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.
Ningde Municipal Hospital, Ningde Normal University, Ningde, Fujian, China.
Diabetol Metab Syndr. 2025 Jan 20;17(1):24. doi: 10.1186/s13098-025-01584-0.
Prior studies on the link between socioeconomic status (SES) and diabetic microvascular complications have been inconclusive. This study aimed to explore whether SES is associated with the risk of diabetic retinopathy (DR), nephropathy (DN) and diabetic peripheral neuropathy (DPN) using large prospective cohort.
SES was evaluated using education attainment (individual level), household income (household level), and Townsend deprivation index (TDI, neighborhood level). This study included 28,339 participants without DR, 29,951 without DN and 29,762 without DPN at baseline from the UK Biobank. Weighted Cox proportional hazard models were used to investigate the relationship between SES and the risk of diabetic microvascular complications.
The median follow-ups of the DR, DN and DPN cohorts were 12.95, 12.89 and 13.02 years, respectively. In total, 3,177 (11.2%) participants developed DR, 4,418 (14.8%) developed DN and 1,604 (5.4%) developed DPN. After adjusting for confounders, higher education levels (DN: hazard ratios [HR] = 0.85; 95% CI, 0.82-0.89; P < 0.001; DPN: HR = 0.93; 95% CI, 0.87-1.00; P = 0.040), higher household income (DN: HR = 0.80; 95% CI, 0.75-0.85; P < 0.001; DPN: HR = 0.80; 95% CI, 0.73-0.89; P < 0.001), and lower TDI (DN: HR = 1.19; 95% CI, 1.14-1.23; P < 0.001; DPN: HR = 1.27; 95% CI, 1.19-1.36; P < 0.001) were associated with a lower risk of DN and DPN. In contrast, a lower risk of DR was only related to higher household income (HR = 0.92; 95% CI, 0.87-0.97; P = 0.004) and lower TDI (HR = 1.08; 95% CI, 1.02-1.13; P = 0.004).
Low SES increases the risk of diabetic microvascular complications, emphasizing the need for equitable medical resource allocation to reduce diabetes-related inequity.
先前关于社会经济地位（SES）与糖尿病微血管并发症之间联系的研究尚无定论。本研究旨在利用大型前瞻性队列探讨SES是否与糖尿病视网膜病变（DR）、肾病（DN）和糖尿病周围神经病变（DPN）的风险相关。
使用教育程度（个体水平）、家庭收入（家庭水平）和汤森贫困指数（TDI，社区水平）评估SES。本研究纳入了英国生物银行中基线时无DR的28339名参与者、无DN的29951名参与者和无DPN的29762名参与者。采用加权Cox比例风险模型研究SES与糖尿病微血管并发症风险之间的关系。
DR、DN和DPN队列的中位随访时间分别为12.95年、12.89年和13.02年。共有3177名（11.2%）参与者发生DR，4418名（14.8%）发生DN，1604名（5.4%）发生DPN。在调整混杂因素后，较高的教育水平（DN：风险比[HR]=0.85；95%置信区间，0.82-0.89；P<0.001；DPN：HR=0.93；9%置信区间，0.87-1.00；P=0.040）、较高的家庭收入（DN：HR=0.80；95%置信区间，0.75-0.85；P<0.001；DPN：HR=0.80；95%置信区间，0.73-0.89；P<0.001）和较低的TDI（DN：HR=1.19；95%置信区间，1.14-1.23；P<0.001；DPN：HR=1.27；95%置信区间，1.19-1.36；P<0.001）与较低的DN和DPN风险相关。相比之下，较低的DR风险仅与较高的家庭收入（HR=0.92；95%置信区间，0.87-0.97；P=0.004）和较低的TDI（HR=1.08；95%置信区间，1.02-1.13；P=0.004）有关。
低SES增加了糖尿病微血管并发症的风险，强调了公平分配医疗资源以减少糖尿病相关不平等的必要性。
