title: Impact of Socioeconomic Status on Cardiovascular Disease and Mortality in 24,947 Individuals With Type 1 Diabetes.
abstract: OBJECTIVE
  Socioeconomic status (SES) is a powerful predictor of cardiovascular disease (CVD) and death. We examined the association in a large cohort of patients with type 1 diabetes.
  
  
  METHODS
  Clinical data from the Swedish National Diabetes Register were linked to national registers, whereby information on income, education, marital status, country of birth, comorbidities, and events was obtained. Patients were followed until a first incident event, death, or end of follow-up. The association between socioeconomic variables and the outcomes was modeled using Cox regression, with rigorous covariate adjustment.
  
  
  RESULTS
  We included 24,947 patients. Mean (SD) age and follow-up was 39.1 (13.9) and 6.0 (1.0) years. Death and fatal/nonfatal CVD occurred in 926 and 1378 individuals. Compared with being single, being married was associated with 50% lower risk of death, cardiovascular (CV) death, and diabetes-related death. Individuals in the two lowest quintiles had twice as great a risk of fatal/nonfatal CVD, coronary heart disease, and stroke and roughly three times as great a risk of death, diabetes-related death, and CV death as individuals in the highest income quintile. Compared with having ≤9 years of education, individuals with a college/university degree had 33% lower risk of fatal/nonfatal stroke. Immigrants had 19%, 33%, and 45% lower risk of fatal/nonfatal CVD, all-cause death, and diabetes-related death, respectively, compared with Swedes. Men had 44%, 63%, and 29% greater risk of all-cause death, CV death, and diabetes-related death.
  
  
  CONCLUSIONS
  Low SES increases the risk of CVD and death by a factor of 2-3 in type 1 diabetes.
authors.affiliation: Sahlgrenska University Hospital, Gothenburg, Sweden Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden araz.rawshani@gu.se.
authors.forename: Araz
authors.initials: A
authors.lastname: Rawshani
authors.affiliation: Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden National Diabetes Register, Centre of Registers, Gothenburg, Sweden.
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Svensson
authors.affiliation: Sahlgrenska University Hospital, Gothenburg, Sweden Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Rosengren
authors.affiliation: Sahlgrenska University Hospital, Gothenburg, Sweden Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Eliasson
authors.affiliation: Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden National Diabetes Register, Centre of Registers, Gothenburg, Sweden.
authors.forename: Soffia
authors.initials: S
authors.lastname: Gudbjörnsdottir
mesh_terms: D000328:Adult; D017668:Age of Onset; D003324:Coronary Artery Disease / Q000401:mortality*; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality*; D003925:Diabetic Angiopathies / Q000401:mortality*; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017678:Sex Distribution; D012923:Social Class; D020521:Stroke / Q000401:mortality*; D013548:Sweden / Q000453:epidemiology