Li Ying, You Qiqi, Fan Menglin, Wei Lingqi, Zeng Jingjing, Chen Bo, Wang Jie, Xu Shaoyong
College of Medicine, Wuhan University of Science & Technology, Wuhan, Hubei, China.
Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.
J Diabetes. 2025 Apr;17(4):e70079. doi: 10.1111/1753-0407.70079.
To investigate whether lower socioeconomic status (SES) was associated with an increased risk of diabetic microvascular complications and to analyze the potential mediating role of several modifiable factors.
The study included 11 309 patients with type 2 diabetes at baseline from the UK Biobank cohort. SES was grouped based on income, education, and employment status by using latent class analysis. Microvascular complications of diabetes were identified through electronic health records. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for microvascular complications across SES groups. Mediation analysis was applied to explore potential mediators in these associations.
During a median follow-up of 12.2 years, 262, 764, and 1017 participants in the high, medium, and low SES groups were diagnosed with microvascular complications. Compared to participants with high SES, those with low SES had a HR of 1.75 (95% CI: 1.53, 2.01) for total microvascular complications, a HR of 2.11 (95% CI: 1.74, 2.55) for nephropathy, a HR of 1.40 (95% CI: 1.14, 1.72) for retinopathy, and a HR of 1.79 (95% CI: 1.32, 2.43) for neuropathy. Mediation analysis indicated that alcohol consumption, body mass index, triglycerides, high density lipoprotein cholesterol, and glycated hemoglobin mediated the association between SES and microvascular complications, with mediation percentages of 1.3%, 12.2%, 4.4%, 10.9%, and 10.8%, respectively.
Lower SES may be associated with a higher risk of diabetic microvascular complications, and obesity-related indicators and glycated hemoglobin may play important mediating roles in the association.
调查较低的社会经济地位（SES）是否与糖尿病微血管并发症风险增加相关，并分析几个可改变因素的潜在中介作用。
该研究纳入了英国生物银行队列中11309例基线时患有2型糖尿病的患者。通过潜在类别分析根据收入、教育程度和就业状况对SES进行分组。通过电子健康记录确定糖尿病微血管并发症。使用Cox回归模型估计各SES组微血管并发症的风险比（HRs）和95%置信区间（CIs）。应用中介分析来探索这些关联中的潜在中介因素。
在中位随访12.2年期间，高、中、低SES组分别有262例、764例和1017例参与者被诊断患有微血管并发症。与高SES参与者相比，低SES参与者总微血管并发症的HR为1.75（95%CI：1.53，2.01），肾病的HR为2.11（95%CI：1.74，2.55），视网膜病变的HR为1.40（95%CI：1.14，1.72），神经病变的HR为1.79（95%CI：1.32，2.43）。中介分析表明，饮酒、体重指数、甘油三酯、高密度脂蛋白胆固醇和糖化血红蛋白介导了SES与微血管并发症之间的关联，中介百分比分别为1.3%、12.2%、4.4%、10.9%和10.8%。
较低的SES可能与糖尿病微血管并发症的较高风险相关，肥胖相关指标和糖化血红蛋白可能在该关联中起重要中介作用。
