Socioeconomic status and risk of diabetes-related mortality in the U.S.
OBJECTIVE
We examined disparities in diabetes-related mortality for socioeconomic status (SES) groups in nationally representative U.S. samples.


METHODS
We analyzed National Health Interview Survey respondents linked to their death records and included those eligible for mortality follow-up who were aged 25 years and older at the time of interview and not missing information on covariates (n=527,426). We measured SES by education and family income. There were 5,613 diabetes-related deaths.


RESULTS
Having less than a high school education was associated with a twofold higher mortality from diabetes, after controlling for age, gender, race/ethnicity, marital status, and body mass index, compared with adults with a college degree or higher education level (relative hazard [RH] = 2.05, 95% confidence interval [CI] 1.78, 2.35). Having a family income below poverty level was associated with a twofold higher mortality after adjustments compared with adults with the highest family incomes (RH=2.41, 95% CI 2.05, 2.84). Approximately one-quarter of the excess risk among those in the lowest SES categories was explained by adjusting for potential confounders.


CONCLUSIONS
Findings from this nationally representative cohort demonstrate a socioeconomic gradient in diabetes-related mortality, with both education and income being important determinants of the risk of death.
Saydah
Sharon
S
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation, Hyattsville, MD 20782, USA. ssaydah@cdc.gov
Lochner
Kimberly
K
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000401:mortality*; D004522:Educational Status; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012923:Social Class; D014481:United States / Q000453:epidemiology