Socioeconomic Disparity in the Prevalence of Objectively Evaluated Diabetes Among Older Japanese Adults: JAGES Cross-Sectional Data in 2010
Socioeconomic Disparity in the Prevalence of Objectively Evaluated Diabetes Among Older Japanese Adults: JAGES Cross-Sectional Data in 2010
复制标题
DOI：
10.2188/jea.je20170206
复制
发表时间：
2019-08-01
影响因子：
4.7
通讯作者：
Kondo, Katsunori
中科院分区：
文献类型：
--
作者：
Nagamine, Yuiko;Kondo, Naoki;Kondo, Katsunori
背景：关于客观评价老年人糖尿病的性别特异性社会经济梯度的研究很少。方法：采用2010年日本老年学评价研究（JAGES）中爱知县9893名65岁及以上无长期护理保险的老年人的横断面数据（回复率：66.3%）。我们收集了人口统计、社会经济（收入、受教育年限和最长职业）和行为信息，采用邮寄自我报告的方式进行调查。在每年的市政健康检查中收集客观评估糖尿病和自我报告病史的血液样本。按性别分层进行泊松回归分析并进行多重归算，计算患病率和95%置信区间。结果：在女性中观察到糖尿病患病率的明显收入梯度，从最低收入四分位数（Q1）的11.7%到最高收入四分位数（Q4）的7.8%。在男性中，这一比例在第一季度为17.6%，第四季度为15.1%。在调整了年龄和其他社会经济因素后，第一季度至第四季度收入的糖尿病患病率比女性为1.43(95%置信区间[CI]， 1.07-1.90)，男性为1.16 （95% CI, 0.90-1.50）。即使在调整了婚姻状况、体重指数、其他代谢风险因素和生活方式因素后，基于收入的梯度在女性中仍然存在。在研究人群中，教育程度和职业与糖尿病无显著相关性。结论：只有女性的糖尿病表现出基于收入的梯度。监测糖尿病患者的收入梯度对公共卫生行动非常重要，即使对老年人群也是如此。未来的纵向研究和干预研究应该评估收入与糖尿病发病的因果关系，确定收入/糖尿病关联中潜在的性别差异的机制，并确定减轻收入不平等的方法。
Background: Studies on sex-specific socioeconomic gradients in objectively evaluated diabetes among older adults are scarce.Methods: We used cross-sectional data of 9,893 adults aged 65 years and older in Aichi Prefecture without long-term care insurance from the Japan Gerontological Evaluation Study (JAGES) in 2010 (Response rate: 66.3%). We collected demographic, socioeconomic (income, years of education, and longest occupation) and behavioral information using a mail-in self-reported survey. Blood samples for the objectively evaluated diabetes and self-reported medical history were collected at annual municipal health checkups. Poisson regression analysis stratified by sex with multiple imputations was conducted to calculate prevalence ratio and 95% confidence interval.Results: A clear income gradient in diabetes prevalence was observed among women, from 11.7% in the lowest income quartile (Q1) to 7.8% in the highest (Q4). Among men, the findings were 17.6% in Q1 to 15.1% in Q4. The prevalence ratios for diabetes with incomes Q1 to Q4 were 1.43 (95% confidence interval [CI], 1.07-1.90) for women and 1.16 (95% CI, 0.90-1.50) for men after adjusting for age and other socioeconomic factors. Even after adjusting for marital status, body mass index, other metabolic risk factors, and lifestyle factors, the income-based gradient remained among women. Education and occupation were not significantly associated with diabetes in the study population.Conclusions: Only women showed an income-based gradient in diabetes. Monitoring income gradient in diabetes is important in public health actions, even in older populations. Future longitudinal and intervention studies should evaluate the causal link of income to diabetes onset, determine the mechanisms of the potential sex differences in the income/diabetes association, and identify ways to mitigate the income-based inequality.