Socioeconomic gradient in morbidity and mortality in people with diabetes: cohort study findings from the Whitehall study and the WHO multinational study of vascular disease in diabetes
Socioeconomic gradient in morbidity and mortality in people with diabetes: cohort study findings from the Whitehall study and the WHO multinational study of vascular disease in diabetes
复制标题
糖尿病患者发病率和死亡率的社会经济梯度：白厅研究和世界卫生组织糖尿病血管疾病多国研究的队列研究结果
DOI：
10.1136/bmj.316.7125.100
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
J. Fuller
中科院分区：
文献类型：
--
作者：
N. Chaturvedi;J. Jarrett;M. Shipley;J. Fuller
目的：评估在一般人群中观察到的逆社会经济死亡率梯度在糖尿病患者中是否持续存在。设计：白厅队列研究和世界卫生组织糖尿病血管疾病跨国研究的伦敦队列。地点：伦敦。受试者：1967-9 年检查了 17 264 名 40-64 岁的男性公务员（17 046 名没有糖尿病，218 名患有糖尿病），1975-7 年检查了来自伦敦诊所的 300 名 35-55 岁糖尿病患者。两组患者均随访至 1995 年 1 月。主要结果指标：全因死亡率、心血管疾病和缺血性心脏病。结果：在这两个队列中，较低社会群体的人年龄较大，血压较高，并且更有可能吸烟。在Whitehall的研究中，与社会地位最高的群体相比，社会地位最低群体的心脏病患病率更高，非糖尿病人群心脏病患病率高出6%（P=0.0001），糖尿病受试者则高出14%（P=0.02）。在世界卫生组织的研究中，与最高社会群体相比，蛋白尿在最低社会群体中更为常见（27% vs 15%，P=0.01），视网膜病变也是如此（54% vs 48%，P=0.5）。两个群体的全因死亡率存在明显的社会经济梯度，最低社会群体的死亡率大约是最高社会群体的两倍。在白厅的研究中，糖尿病和非糖尿病受试者的这一梯度相似，并且心血管疾病和缺血性心脏病的死亡率持续存在。在最低社会群体中，大约有一半的死亡风险增加是由血压和吸烟造成的。结论：我们证实糖尿病患者存在逆社会经济死亡率梯度，并表明这很大程度上是由于传统的心血管危险因素造成的。关键信息 社会阶层较低的人往往比较高阶层的人有更高的死亡率，但芬兰的一项研究发现，糖尿病患者的死亡率不存在这样的社会经济梯度。 为了回应这项研究，我们在两项大型研究中检查了死亡率，对 17 264 名白厅公务员（其中 218 名患有糖尿病）和 300 名在伦敦糖尿病诊所就诊的患者进行了 20 年的随访。吸烟与高血压在最低社会群体中的关系，而血糖浓度对这种关系影响不大。这些结果强调了改善传统心血管危险因素和减少社会不平等对于降低糖尿病患者死亡率的重要性
Objectives: To assess whether the inverse socioeconomic mortality gradient observed in the general population persists in diabetic people. Design: The Whitehall cohort study and the London cohort of the WHO multinational study of vascular disease in diabetes. Setting: London. Subjects: 17 264 male civil servants (17 046 without diabetes, 218 with diabetes) aged 40–64 examined in 1967-9, and 300 people with diabetes aged 35–55 from London clinics examined in 1975-7. Both cohorts were followed up until January 1995. Main outcome measures: Mortality from all causes, cardiovascular disease, and ischaemic heart disease. Results: In both cohorts people in the lower social groups were older, had higher blood pressure, and were more likely to smoke. In the Whitehall study, the prevalence of heart disease was higher in the lowest social group compared with the highest group, by 6% among non-diabetic people (P=0.0001) and by 14% among diabetic subjects (P=0.02). In the WHO study proteinuria was more common in the lowest social group compared with the highest (27% v 15%, P=0.01), as was retinopathy (54% v 48%, P=0.5). There was a clear socioeconomic gradient in all cause mortality in both cohorts, with death rates being about twice as high in the lowest compared with the highest social groups. In the Whitehall study this gradient was similar in both diabetic and non-diabetic subjects, and it persisted for mortality from cardiovascular disease and from ischaemic heart disease. About half of the increased risk of death in the lowest social group was accounted for by blood pressure and smoking. Conclusions: We confirm the existence of an inverse socioeconomic mortality gradient in diabetic people and suggest that this is largely due to conventional cardiovascular risk factors. Key messages People in lower social classes tend to have higher mortality than those in higher classes, but a Finnish study found no such socioeconomic gradient in mortality among diabetic people In response to this research we examined mortality in two large studies with 20 year follow up of 17 264 Whitehall civil servants (218 with diabetes) and 300 patients attending diabetes clinics in London Mortality was twice as high in diabetic people in the lowest socioeconomic groups as in those in the highest groups This difference was largely due to higher rates of smoking and high blood pressure in the lowest social groups, while blood glucose concentration had little impact on the relation These results emphasise the importance of improving conventional cardiovascular risk factors and reducing social inequality for reducing mortality in diabetic people