Li Jie, Li Jiang, Fu Yanqi, Zhang Kun, Tan Xiao, Wang Ningjian, Qi Lu, Lu Yingli, Wang Bin
Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Department of Big Data in Health Science, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
Am J Med. 2025 May 5. doi: 10.1016/j.amjmed.2025.05.001.
Adverse health behaviors have been found to play a role in linking socioeconomic deprivation and mortality, but relevant evidence in patients with type 2 diabetes is lacking. We aimed to quantify the mediation effect of overall lifestyles on the association between socioeconomic deprivation and premature mortality as well as the interaction of deprivation and lifestyle in diabetes.
This cohort study included 20,463 UK Biobank participants with type 2 diabetes at recruitment between 2006 and 2010. Socioeconomic deprivation level was determined using the Townsend deprivation index. An overall lifestyle score was constructed based on 6 health behaviors including smoking, alcohol consumption, physical activity, diet, sleep duration, and television viewing time. Cox proportional hazards models were employed to investigate the associations of socioeconomic deprivation and lifestyle with premature mortality.
Over a mean follow-up of 7.4-12.7 years, 3381, 2382, 1281, and 577 patients with diabetes died before ages 80, 75, 70, and 65 years, respectively. High socioeconomic deprivation showed an association with a higher risk of premature mortality that was partially mediated by overall lifestyles. A significant interaction was found between lifestyle and deprivation on premature mortality, which became more apparent as age at death decreased. The adjusted hazard ratio (HR) for death before age 80 years when comparing the unfavorable versus favorable lifestyle was 1.49 (95% CI 1.21-1.82) in the least deprived group and 1.92 (1.56-2.36) in the most deprived group. Equivalent HRs for death before age 65 years were 1.33 (0.76-2.33) and 3.78 (2.04-7.02), respectively.
In patients with type 2 diabetes, unhealthy lifestyles mediated the association between socioeconomic deprivation and premature mortality and conferred disproportionate risk of premature mortality in more deprived groups.
不良健康行为已被发现与社会经济剥夺和死亡率之间存在关联，但2型糖尿病患者的相关证据尚缺。我们旨在量化总体生活方式在社会经济剥夺与过早死亡之间关联中的中介作用，以及在糖尿病中剥夺与生活方式的相互作用。
这项队列研究纳入了2006年至2010年招募时患有2型糖尿病的20463名英国生物银行参与者。使用汤森德剥夺指数确定社会经济剥夺水平。基于包括吸烟、饮酒、体育活动、饮食、睡眠时间和看电视时间在内的6种健康行为构建总体生活方式得分。采用Cox比例风险模型研究社会经济剥夺和生活方式与过早死亡之间的关联。
在平均7.4至12.7年的随访期间，分别有3381、2382、1281和577例糖尿病患者在80岁、75岁、70岁和65岁之前死亡。高社会经济剥夺与过早死亡风险较高相关，这部分由总体生活方式介导。在过早死亡方面，发现生活方式与剥夺之间存在显著相互作用，随着死亡年龄降低，这种相互作用变得更加明显。在最不贫困组中，比较不良生活方式与良好生活方式时，80岁前死亡的调整后风险比（HR）为1.49（95%CI 1.21 - 1.82），在最贫困组中为1.92（1.56 - 2.36）。65岁前死亡的等效HR分别为1.33（0.76 - 2.33）和3.78（2.04 - 7.02）。
在2型糖尿病患者中，不健康的生活方式介导了社会经济剥夺与过早死亡之间的关联，并在更贫困群体中带来了不成比例的过早死亡风险。
