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Socioeconomic position and the incidence of type 2 diabetes: the ELSA study

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Abstract

We examined the associations between childhood and adult socioeconomic position (SEP) and incident diabetes in 7,432 individuals aged 50 or older from the English Longitudinal Study of Ageing (ELSA). We identified 174 and 189 cases of incident diabetes, in men and women, respectively, over 5.3 years of follow-up. Cox models were estimated. In women, childhood SEP, education, occupational class, income, wealth, and subjective social status (SSS) were related to incident diabetes. Occupational class, income, and SSS did not remain significantly related to incident diabetes after adjustment for individual sets of covariates (i.e. unhealthy behaviours, obesity, or psychosocial factors). Wealth (HR: 1.65, 95 % CI: 1.05, 2.60, poorest vs. wealthiest tertile) remained significantly related to incident diabetes after adjustment for all covariates, but education (HR: 1.46, 95 % CI: 0.92, 2.33, lowest vs. highest category) and childhood SEP (HR: 1.47, 95 % CI: 0.98, 2.19, lowest vs. highest category) did not. In men, only wealth and SSS were related to incident diabetes. SSS remained significantly related to incident diabetes after adjustment for all covariates (HR: 2.46, 95 % CI: 1.32, 4.68, lowest vs. highest category), but wealth did not (HR: 1.42, 95 % CI: 0.94, 2.15, poorest vs. wealthiest tertile). Additional adjustment for wealth did not greatly affect the association between incident diabetes and SSS in men. Incident diabetes in older women is associated with SEP from all life stages, while in older men only with current SEP. Psychosocial factors (in women), unhealthy behaviours, and obesity partly mediate these associations.

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References

  1. Robbins JM, Vaccarino V, Zhang H, Kasl SV. Socioeconomic status and diagnosed diabetes incidence. Diabetes Res Clin Pract. 2005;68:230–6.

    Article  PubMed  Google Scholar 

  2. Maty SC, Everson-Rose SA, Haan MN, Raghunathan TE, Kaplan GA. Education, income, occupation, and the 34-year incidence (1965–99) of type 2 diabetes in the Alameda County Study. Int J Epidemiol. 2005;34:1274–81.

    Article  PubMed  Google Scholar 

  3. Maty SC, Lynch JW, Raghunathan TE, Kaplan GA. Childhood socioeconomic position, gender, adult body mass index, and incidence of type 2 diabetes mellitus over 34 years in the Alameda County Study. Am J Public Health. 2008;98:1486–94.

    Article  PubMed  Google Scholar 

  4. Ross NA, Gilmour H, Dasgupta K. 14-Year diabetes incidence: the role of socio-economic status. Health Rep. 2010;21:19–28.

    PubMed  Google Scholar 

  5. Tamayo T, Christian H, Rathmann W. Impact of early psychosocial factors (childhood socioeconomic factors and adversities) on future risk of type 2 diabetes, metabolic disturbances and obesity: a systematic review. BMC Public Health. 2010;10:525.

    Article  PubMed  Google Scholar 

  6. Kumari M, Head J, Marmot M. Prospective study of social and other risk factors for incidence of type 2 diabetes in the Whitehall II study. Arch Intern Med. 2004;27(164):1873–80.

    Article  Google Scholar 

  7. Williams ED, Tapp RJ, Magliano DJ, Shaw JE, Zimmet PZ, Oldenburg BF. Health behaviours, socioeconomic status and diabetes incidence: the Australian Diabetes Obesity and Lifestyle Study (AusDiab). Diabetologia. 2010;53:2538–45.

    Article  PubMed  CAS  Google Scholar 

  8. Agardh E, Allebeck P, Hallqvist J, Moradi T, Sidorchuk A. Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. Int J Epidemiol. 2011;40:804–18.

    Article  PubMed  Google Scholar 

  9. Best LE, Hayward MD, Hidajat MM. Life course pathways to adult-onset diabetes. Soc Biol. 2005;52:94–111.

    PubMed  Google Scholar 

  10. Tanaka T, Gjonca E, Gulliford MC. Income, wealth and risk of diabetes among older adults: cohort study using the English Longitudinal Study of Ageing. Eur J Public Health. 2011. doi:10.1093/eurpub/ckr050.

  11. Kowall B, Rathmann W, Strassburger K, Meisinger C, Holle R, Mielck A. Socioeconomic status is not associated with type 2 diabetes incidence in an elderly population in Germany: KORA S4/F4 Cohort Study. J Epidemiol Community Health. 2011;65:606–12.

    Article  PubMed  Google Scholar 

  12. Ben-Shlomo Y, Kuh D. A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. Int J Epidemiol. 2002;31:285–93.

    Article  PubMed  Google Scholar 

  13. Oliver ML, Shapiro TM. Black wealth/white wealth. New York: Routledge; 1995.

    Google Scholar 

  14. Robert S, House JS. SES differentials in health by age and alternative indicators of SES. J Aging Health. 1996;8:359–88.

    Article  PubMed  CAS  Google Scholar 

  15. Daly MC, Duncan GJ, McDonough P, Williams DR. Optimal indicators of socioeconomic status for health research. Am J Public Health. 2002;92:1151–7.

    Article  PubMed  Google Scholar 

  16. Hurd MD. The economic status of the elderly. Science. 1989;12(244):659–64.

    Article  Google Scholar 

  17. Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Metzler M, et al. Socioeconomic status in health research: one size does not fit all. JAMA. 2005;14(294):2879–88.

    Article  Google Scholar 

  18. Jackman MR, Jackman RW. Interpretation of relation between objective and subjective social status. Am Soc Rev. 1973;38:569–82.

    Article  CAS  Google Scholar 

  19. Adler NE, Epel ES, Castellazzo G, Ickovics JR. Relationship of subjective and objective social status with psychological and physiological functioning: preliminary data in healthy white women. Health Psychol. 2000;19:586–92.

    Article  PubMed  CAS  Google Scholar 

  20. Demakakos P, Nazroo J, Breeze E, Marmot M. Socioeconomic status and health: the role of subjective social status. Soc Sci Med. 2008;67:330–40.

    Article  PubMed  Google Scholar 

  21. Mezuk B, Eaton WW, Albrecht S, Golden SH. Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care. 2008;31:2383–90.

    Article  PubMed  Google Scholar 

  22. Barth J, Schneider S, von Kanel R. Lack of social support in the etiology and the prognosis of coronary heart disease: a systematic review and meta-analysis. Psychosom Med. 2010;72:229–38.

    Article  PubMed  Google Scholar 

  23. van Dam HA, van der Horst FG, Knoops L, Ryckman RM, Crebolder HF, van den Borne BH. Social support in diabetes: a systematic review of controlled intervention studies. Patient Educ Couns. 2005;59:1–12.

    Article  PubMed  Google Scholar 

  24. Chandola T, Kuper H, Singh-Manoux A, Bartley M, Marmot M. The effect of control at home on CHD events in the Whitehall II study: gender differences in psychosocial domestic pathways to social inequalities in CHD. Soc Sci Med. 2004;58:1501–9.

    Article  PubMed  Google Scholar 

  25. DeVogli R, Chandola T, Marmot MG. Negative aspects of close relationships and heart disease. Arch Intern Med. 2007;8(167):1951–7.

    Article  Google Scholar 

  26. Jeon CY, Lokken RP, Hu FB, van Dam RM. Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review. Diabetes Care. 2007;30:744–52.

    Article  PubMed  Google Scholar 

  27. Gill JM, Cooper AR. Physical activity and prevention of type 2 diabetes mellitus. Sports Med. 2008;38:807–24.

    Article  PubMed  Google Scholar 

  28. Willi C, Bodenmann P, Ghali WA, Faris PD, Cornuz J. Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis. JAMA. 2007;12(298):2654–64.

    Article  Google Scholar 

  29. Fogelholm M. Physical activity, fitness and fatness: relations to mortality, morbidity and disease risk factors. A systematic review. Obes Rev. 2010;11:202–21.

    Article  PubMed  CAS  Google Scholar 

  30. Qiao Q, Nyamdorj R. Is the association of type II diabetes with waist circumference or waist-to-hip ratio stronger than that with body mass index? Eur J Clin Nutr. 2010;64:30–4.

    Article  PubMed  CAS  Google Scholar 

  31. Lynch JW, Kaplan GA, Salonen JT. Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse. Soc Sci Med. 1997;44:809–19.

    Article  PubMed  CAS  Google Scholar 

  32. Wardle J, Steptoe A. Socioeconomic differences in attitudes and beliefs about healthy lifestyles. J Epidemiol Community Health. 2003;57:440–3.

    Article  PubMed  CAS  Google Scholar 

  33. Ajrouch KJ, Blandon AY, Antonucci TC. Social networks among men and women: the effects of age and socioeconomic status. J Gerontol B Psychol Sci Soc Sci. 2005;60:S311–7.

    Article  PubMed  Google Scholar 

  34. Rosengren A, Orth-Gomer K, Wilhelmsen L. Socioeconomic differences in health indices, social networks and mortality among Swedish men. A study of men born in 1933. Scand J Soc Med. 1998;26:272–80.

    PubMed  CAS  Google Scholar 

  35. Demakakos P, Hamer M, Stamatakis E, Steptoe A. Low-intensity physical activity is associated with reduced risk of incident type 2 diabetes in older adults: evidence from the English Longitudinal Study of Ageing. Diabetologia. 2010;53:1877–85.

    Article  PubMed  CAS  Google Scholar 

  36. Steffick DE. Documentation of affective functioning measures in the health and retirement study. Ann Arbor, MI: HRS Health Working Group. Report no.: DR-005.2000. http://hrsonline.isr.umich.edu/sitedocs/userg/dr-005.pdf. Accessed 30 Mar 2012.

  37. Demakakos P, Pierce MB, Hardy R. Depressive symptoms and risk of type 2 diabetes in a national sample of middle-aged and older adults: the English longitudinal study of aging. Diabetes Care. 2010;33:792–7.

    Article  PubMed  Google Scholar 

  38. Norberg M, Stenlund H, Lindahl B, Andersson C, Eriksson JW, Weinehall L. Work stress and low emotional support is associated with increased risk of future type 2 diabetes in women. Diabetes Res Clin Pract. 2007;76:368–77.

    Article  PubMed  CAS  Google Scholar 

  39. Lidfeldt J, Li TY, Hu FB, Manson JE, Kawachi I. A prospective study of childhood and adult socioeconomic status and incidence of type 2 diabetes in women. Am J Epidemiol. 2007;15(165):882–9.

    Article  Google Scholar 

  40. Krishnan S, Cozier YC, Rosenberg L, Palmer JR. Socioeconomic status and incidence of type 2 diabetes: results from the Black Women’s Health Study. Am J Epidemiol. 2010;1(171):564–70.

    Article  Google Scholar 

  41. Smith BT, Lynch JW, Fox CS, Harper S, Abrahamowicz M, Almeida ND, et al. Life-course socioeconomic position and type 2 diabetes mellitus: the Framingham Offspring Study. Am J Epidemiol. 2011;15(173):438–47.

    Article  Google Scholar 

  42. Agardh EE, Ahlbom A, Andersson T, Efendic S, Grill V, Hallqvist J, et al. Work stress and low sense of coherence is associated with type 2 diabetes in middle-aged Swedish women. Diabetes Care. 2003;26:719–24.

    Article  PubMed  Google Scholar 

  43. Agardh EE, Ahlbom A, Andersson T, Efendic S, Grill V, Hallqvist J, et al. Explanations of socioeconomic differences in excess risk of type 2 diabetes in Swedish men and women. Diabetes Care. 2004;27:716–21.

    Article  PubMed  Google Scholar 

  44. Eriksson JG, Forsen TJ, Osmond C, Barker DJ. Pathways of infant and childhood growth that lead to type 2 diabetes. Diabetes Care. 2003;26:3006–10.

    Article  PubMed  Google Scholar 

  45. Kajantie E, Osmond C, Barker DJ, Eriksson JG. Preterm birth—a risk factor for type 2 diabetes? The Helsinki birth cohort study. Diabetes Care. 2010;33:2623–5.

    Article  PubMed  Google Scholar 

  46. Osmond C, Barker DJ. Fetal, infant, and childhood growth are predictors of coronary heart disease, diabetes, and hypertension in adult men and women. Environ Health Perspect. 2000;108(Suppl 3):545–53.

    PubMed  Google Scholar 

  47. Buren J, Eriksson JW. Is insulin resistance caused by defects in insulin’s target cells or by a stressed mind? Diabetes Metab Res Rev. 2005;21:487–94.

    Article  PubMed  CAS  Google Scholar 

  48. Loucks EB, Rehkopf DH, Thurston RC, Kawachi I. Socioeconomic disparities in metabolic syndrome differ by gender: evidence from NHANES III. Ann Epidemiol. 2007;17:19–26.

    Article  PubMed  Google Scholar 

  49. Marmot M, Wilkinson RG. Psychosocial and material pathways in the relation between income and health: a response to Lynch et al. BMJ. 2001;19(322):1233–6.

    Article  Google Scholar 

  50. Pierce MB, Zaninotto P, Steel N, Mindell J. Undiagnosed diabetes-data from the English Longitudinal Study of Ageing. Diabet Med. 2009;26:679–85.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Epidemiology and Public Health, University College London (UCL), 1-19 Torrington Place, London, WC1E 6BT, UK

    Panayotes Demakakos, Michael Marmot & Andrew Steptoe

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  1. Panayotes Demakakos
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  2. Michael Marmot
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Correspondence to Panayotes Demakakos.

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Demakakos, P., Marmot, M. & Steptoe, A. Socioeconomic position and the incidence of type 2 diabetes: the ELSA study. Eur J Epidemiol 27, 367–378 (2012). https://doi.org/10.1007/s10654-012-9688-4

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  • DOI: https://doi.org/10.1007/s10654-012-9688-4

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