Socioeconomic position and cardiovascular disease in adults with and without diabetes: United States trends, 1997-2005.
BACKGROUND
Diabetes and its cardiovascular complications are more common in adults of low socioeconomic position (SEP). In the US, the past decade has seen the establishment of many programs to reduce cardiovascular risk in persons with diabetes, but their effect on socioeconomic disparities is uncertain.


OBJECTIVE
We sought to investigate recent time trends in socioeconomic disparities in cardiovascular disease (CVD) among persons with and without diabetes.


METHODS
Two hundred fifty-five thousand nine hundred sixty-six individuals aged 25 years or older included in the National Health Interview Survey between 1997 and 2005.


METHODS
Educational attainment was used as a marker for SEP and self-reported history of CVD as the main outcome. Educational disparities were measured using prevalence rate ratios (PRR) and the relative index of inequalities (RII).


RESULTS
Among adults with diabetes, CVD prevalence was persistently higher in those who did not complete high school (HS) than in college graduates (adjusted PRR [aPRR] 1.20, 95% confidence interval [95%CI] 1.05-1.38 in 1997-1999, and aPRR 1.12, 95% CI 1.00-1.25 in 2003-2005). However, the HS vs. college graduates disparity in CVD declined from 1997-1999 (aPRR 1.20, 95% CI 1.04-1.37) to 2003-2005 (aPRR 1.01, 95% CI 0.90-1.12). Among adults without diabetes educational disparities in CVD widened markedly over time.


CONCLUSIONS
Concurrently with improvements in diabetes management, the widening of socioeconomic health disparities has remained limited in the diabetic population during the past decade. This provides evidence for the potential impact of improvements in disparities in health care access and process, such as experienced among persons with diabetes, in limiting socioeconomic health disparities.
Dray-Spira
Rosemary
R
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA. Rosemary.Dray-Spira@inserm.fr
Gary
Tiffany L
TL
Brancati
Frederick L
FL
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000191:economics* / Q000453:epidemiology; D048909:Diabetes Complications / Q000191:economics* / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000191:economics / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology