title: Associations between socioeconomic status and major complications in type 1 diabetes: the Pittsburgh epidemiology of diabetes complication (EDC) Study.
abstract: OBJECTIVE
  To understand the effect of socioeconomic status (SES) on the risk of complications in type 1 diabetes (T1D), we explored the relationship between SES and major diabetes complications in a prospective, observational T1D cohort study.
  
  
  METHODS
  Complete data were available for 317 T1D persons within 4 years of age 28 (ages 24-32) in the Pittsburgh Epidemiology of Diabetes Complications Study. Age 28 was selected to maximize income, education, and occupation potential and to minimize the effect of advanced diabetes complications on SES.
  
  
  RESULTS
  The incidences over 1 to 20 years' follow-up of end-stage renal disease and coronary artery disease were two to three times greater for T1D individuals without, compared with those with a college degree (p < .05 for both), whereas the incidence of autonomic neuropathy was significantly greater for low-income and/or nonprofessional participants (p < .05 for both). HbA(1c) was inversely associated only with income level. In sex- and diabetes duration-adjusted Cox models, lower education predicted end-stage renal disease (hazard ratio [HR], 2.9; 95% confidence interval [95% CI], 1.1-7.7) and coronary artery disease (HR, 2.5, 95% CI, 1.3-4.9), whereas lower income predicted autonomic neuropathy (HR, 1.7; 95% CI, 1.0-2.9) and lower-extremity arterial disease (HR, 3.7; 95% CI, 1.1-11.9).
  
  
  CONCLUSIONS
  These associations, partially mediated by clinical risk factors, suggest that lower SES T1D individuals may have poorer self-management and, thus, greater complications from diabetes.
authors: Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
authors: Aaron M
authors: AM
authors: Secrest
authors: Tina
authors: T
authors: Costacou
authors: Bruce
authors: B
authors: Gutelius
authors: Rachel G
authors: RG
authors: Miller
authors: Thomas J
authors: TJ
authors: Songer
authors: Trevor J
authors: TJ
authors: Orchard
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D016001:Confidence Intervals; D048909:Diabetes Complications / Q000453:epidemiology* / Q000401:mortality; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality*; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D011446:Prospective Studies; D012923:Social Class; D055815:Young Adult