title: Independent roles of country of birth and socioeconomic status in the occurrence of type 2 diabetes.
abstract: BACKGROUND
  There is strong evidence based on previous studies that ethnicity and socioeconomic status are important determinants of diversity in the occurrence of diabetes. However, the independent roles of socioeconomic status, country of birth and lifestyle factors in the occurrence of type 2 diabetes have not been clearly identified. This study investigated the relationships between socioeconomic status, country of birth and type 2 diabetes in a large diverse sample of residents of New South Wales, Australia, and aged 45 years and over.
  
  
  METHODS
  The analysis used self-reported baseline questionnaire data from 266,848 participants in the 45 and Up Study. Educational attainment, work status and income were used as indicators of socioeconomic status. Logistic regression models were built to investigate associations between socioeconomic status, country of birth and type 2 diabetes.
  
  
  RESULTS
  The adjusted odds of type 2 diabetes were significantly higher for people born in many overseas countries, compared to Australian-born participants. Compared with participants who had a university degree or higher qualification, the adjusted odds ratio (OR) for diabetes was higher in all other educational categories. Diabetes was more prevalent in people who were retired, unemployed or engaged in other types of work, compared with people who were in paid work. The prevalence of diabetes was higher in people with lower incomes. Compared with people who earned more than $50,000, the adjusted OR for diabetes was 2.05 (95% CI 1.95-2.14) for people who had an income less than $20,000 per annum. The relationships between socioeconomic factors and country of birth and diabetes were attenuated slightly when all were included in the model. Addition of smoking, obesity and physical activity to the model had marked impacts on adjusted ORs for some countries of birth, but relationships between diabetes and all measures of socioeconomic status and country of birth remained strong and significant.
  
  
  CONCLUSIONS
  Country of birth and socioeconomic status are independent predictors of type 2 diabetes. However, in this population, country of birth had a stronger association with type 2 diabetes.
authors.affiliation: School of Medicine, University of Western Sydney, Sydney, Australia. m.shamshirgaran@hotmail.com.
authors.forename: Seyed Morteza
authors.initials: SM
authors.lastname: Shamshirgaran
authors.forename: Louisa
authors.initials: L
authors.lastname: Jorm
authors.forename: Hilary
authors.initials: H
authors.lastname: Bambrick
authors.forename: Annemarie
authors.initials: A
authors.lastname: Hennessy
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000209:etiology; D004522:Educational Status; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009517:New South Wales / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires