https://diabetes.acponline.org/archives/2016/07/15/3.htm

Socioeconomic status appears linked to mortality in patients with type 2 diabetes

The study looked at data from the Sweden National Diabetes Register to determine what patient characteristics were related to all-cause mortality or death from cardiovascular-, diabetes-, or cancer-related causes.


In a study of Swedish patients with type 2 diabetes who had similar access to health care, socioeconomic status appeared to be a strong predictor of all-cause mortality as well as cardiovascular (CV) and diabetes-related mortality.

Researchers used data from the Sweden National Diabetes Register from Jan. 1, 2003, to Dec. 31, 2010, to examine whether income, education, marital status, and country of birth were independently associated with all-cause mortality or death from CV-, diabetes-, or cancer-related causes in patients with type 2 diabetes. All Swedish citizens have equal access to health care, and individual costs of health care in Sweden are low. The study included 217,364 patients who were younger than age 70 and had type 2 diabetes. Results were published June 27 by JAMA Internal Medicine.

The study population had a mean age of 58.3 years, and 130,839 (60.2%) were men. Overall, 19,105 patients died during the study period, 11,423 (59.8%) of CV-related causes, 6,984 (36.6%) of diabetes-related causes, and 6,438 (33.7%) of cancer-related causes. Married patients were at lower risk for all-cause mortality (hazard ratio [HR], 0.73), CV-related death (HR, 0.67), and diabetes-related death (HR, 0.62) than single patients, but no association was seen between marital status and overall cancer death, although married men had a lower risk for prostate cancer (HR, 0.67).

Hazard ratios for the lowest versus highest income quintiles were 1.71 (95% CI, 1.60 to 1.83) for all-cause mortality, 1.87 (95% CI, 1.72 to 2.05) for CV-related mortality, 1.80 (95% CI, 1.61 to 2.01) for diabetes-related mortality, and 1.28 (95% CI, 1.14 to 1.44) for cancer mortality. For patients with a college or university degree versus those with 9 years of education or less, hazard ratios were 0.85 (95% CI, 0.80 to 0.90) for all-cause mortality, 0.84 (95% CI, 0.78 to 0.91) for CV-related mortality, and 0.84 (95% CI, 0.76 to 0.93) for cancer-related mortality.

The authors noted that their study design was observational, that no data were available on alcohol consumption, that data on smoking were limited, and that the cohort may have included patients with type 1 diabetes if their disease onset occurred after age 40. However, they concluded that in this study of patients with type 2 diabetes and equitable, affordable access to health care, lower socioeconomic status was associated with a significantly higher risk for all-cause, CV, and diabetes-related death, as well as a smaller increased risk for cancer-related death.

“Controlling for conventional risk factors does not eliminate these disparities,” the authors wrote, “but socioeconomically tailored management and aggressive treatment are likely to reduce them.”