Association of Socioeconomic Status with Mortality in Type 1 Diabetes: The Pittsburgh Epidemiology of Diabetes Complications Study
Association of Socioeconomic Status with Mortality in Type 1 Diabetes: The Pittsburgh Epidemiology of Diabetes Complications Study
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DOI：
10.1016/j.annepidem.2011.02.011
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发表时间：
2011-05-01
影响因子：
5.6
通讯作者：
Orchard, Trevor J.
中科院分区：
文献类型：
--
作者：
Secrest, Aaron M.;Costacou, Tina;Orchard, Trevor J.
目的：社会经济地位 (SES) 作为 1 型糖尿病 (T1D) 死亡的危险因素尚未得到充分的前瞻性研究。 方法：匹兹堡糖尿病并发症流行病学研究的 317 名 T1D 参与者的完整临床和 SES（收入、教育、职业）数据均在 4 岁 28 岁以内（选择最大化收入、教育和职业潜力，并最小化社会经济地位的影响）。晚期糖尿病并发症）。截至 2008 年 1 月 1 日确定了生命状况。 结果：在平均 16 年的随访中，发生了 34 例 (10.7%) 死亡（标准化死亡率 [SMR] = 4.1，95% 置信区间 [CI]：2.7-5.5）。对于受教育程度最高和收入最高的群体来说，SMR 与一般人群没有差异，而在社会经济地位较低的群体中，SMR 有所增加。拥有大学学位的人的死亡率比没有大学学位的人低三倍（p = 0.004），最高收入群体的死亡率比低收入群体低近四倍（p = 0.04）。在调整糖尿病病程和性别的 Cox 模型中，教育是预测死亡率的唯一 SES 指标（风险比 [HR] = 3.0，95% CI：1.2-7.8），但在调整 HbA(1c)、非 HDL 胆固醇、高血压和微量白蛋白尿后失去显着性（HR = 2.1，95% CI：0.8-5.6）。结论：教育与死亡率密切相关。 T1D 部分由更好的血糖、血脂和血压控制介导。安流行病学 2011；21：367-373。 (C) 2011 Elsevier Inc. 保留所有权利。
PURPOSE: Socioeconomic status (SES) as a risk factor for mortality in type 1 diabetes (T1D) has not been adequately studied prospectively.METHODS: Complete clinical and SES (income, education, occupation) data were available for 317 T1D participants in the Pittsburgh Epidemiology of Diabetes Complications Study within 4 years of age 28 (chosen to maximize income, education, and occupational potential, and to minimize the SES effect of advanced diabetes complications). Vital status was determined as of 1/1/2008.RESULTS: Over a median 16 years of follow-up, 34 (10.7%) deaths occurred (standardized mortality ratios [SMRs] = 4.1, 95% confidence interval [CI]: 2.7-5.5). SMRs did not differ from the general population for those in the highest education and income groups, whereas in those with low SES, SMRs were increased. Mortality rates were three times lower for individuals with a college degree versus without a college degree (p = 0.004) and nearly four times lower for the highest income versus lower income groups (p = 0.04). In Cox models adjusting for diabetes duration and sex, education was the only SES measure predictive of mortality (hazard ratio [HR] = 3.0, 95% CI: 1.2-7.8), but lost significance after adjusting for HbA(1c), non-HDL cholesterol, hypertension, and microalbuminuria (HR = 2.1, 95% CI: 0.8-5.6).CONCLUSIONS: The strong association of education with mortality in T1D is partially mediated by better glycemic, lipid, and blood pressure control. Ann Epidemiol 2011;21:367-373. (C) 2011 Elsevier Inc. All rights reserved.