To understand the effect of socioeconomic status (SES) on the risk of complications
in type 1 diabetes (T1D), we explored the relationship between SES and major diabetes
complications in a prospective, observational T1D cohort study.
Complete data were available for 317 T1D persons within 4 years of age 28 (ages 24-32)
in the Pittsburgh Epidemiology of Diabetes Complications Study. Age 28 was selected
to maximize income, education, and occupation potential and to minimize the effect
of advanced diabetes complications on SES.
The incidences over 1 to 20 years' follow-up of end-stage renal disease and coronary
artery disease were two to three times greater for T1D individuals without, compared
with those with a college degree (p < .05 for both), whereas the incidence of autonomic
neuropathy was significantly greater for low-income and/or nonprofessional participants
(p < .05 for both). HbA(1c) was inversely associated only with income level. In sex-
and diabetes duration-adjusted Cox models, lower education predicted end-stage renal
disease (hazard ratio [HR], 2.9; 95% confidence interval [95% CI], 1.1-7.7) and coronary
artery disease (HR, 2.5, 95% CI, 1.3-4.9), whereas lower income predicted autonomic
neuropathy (HR, 1.7; 95% CI, 1.0-2.9) and lower-extremity arterial disease (HR, 3.7;
95% CI, 1.1-11.9).
These associations, partially mediated by clinical risk factors, suggest that lower
SES T1D individuals may have poorer self-management and, thus, greater complications
from diabetes.
Copyright © 2011 Elsevier Inc. All rights reserved.