title: Low socioeconomic status is associated with increased risk for hypoglycemia in diabetes patients: the Diabetes Study of Northern California (DISTANCE).
abstract: BACKGROUND
  Social risk factors for hypoglycemia are not well understood.
  
  
  METHODS
  Cross-sectional analysis from the DISTANCE study, a multi-language, ethnically-stratified random sample of adults in the Kaiser Permanente Northern California diabetes registry, conducted in 2005-2006 (response rate 62%). Exposures were income and educational attainment; outcome was patient report of severe hypoglycemia. To test the association, we used multivariable logistic regression to adjust for demographic and clinical factors.
  
  
  RESULTS
  14,357 patients were included. Reports of severe hypoglycemia were common (11%), and higher in low-income vs. high-income (16% vs. 8.8) and low-education vs. high-education (11.9% vs. 8.9%) groups. In multivariable analysis, incomes of less than $15,000 (OR 1.51 95%CI 1.19-1.91), $15,000-$24,999 (OR 1.57 95%CI 1.27-1.94), and high school or less education (OR 1.42, 95% CI 1.24-1.63) were associated with increased hypoglycemia, similar to insulin use (OR 1.44 95%CI 1.19-1.74).
  
  
  CONCLUSIONS
  Low income and educational attainment are important risk factors for hypoglycemia.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Berkowitz
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
authors.forename: Courtney R
authors.initials: CR
authors.lastname: Lyles
authors.forename: Jennifer Y
authors.initials: JY
authors.lastname: Liu
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Adler
authors.forename: Howard H
authors.initials: HH
authors.lastname: Moffet
authors.forename: Urmimala
authors.initials: U
authors.lastname: Sarkar
mesh_terms: D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004522:Educational Status; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D007182:Income; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors