title: Gender differences in cumulative life-course socioeconomic position and social mobility in relation to new onset diabetes in adults-the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
abstract: We investigated gender-specific associations of cumulative socioeconomic position across life course and social mobility with new onset diabetes mellitus (NODM) in over 12,000 civil servants in Brazil.
  
  
  
  We used data from ELSA-Brasil baseline (2008-2010). The accumulation of risk was assessed using an education-based score and an occupation-based score. Educational and occupational social mobility were also evaluated.
  
  
  
  In minimally adjusted models, NODM increased with increasing exposure to life-course social disadvantages, especially in men. This gender difference was pronounced when cumulative processes were evaluated by education-based scores (high vs. low cumulative social disadvantage, odds ratio [OR] = 4.7; 95% confidence interval [CI]: 2.6-8.5 in men and OR = 2.0; 95% CI: 1.1-3.6 in women). After including proximal diabetes risk factors possibly acting as mediators, these associations remained high only in men (high vs. low cumulative social disadvantage, OR = 4.4; 95% CI: 2.4-8.1). Social mobility was associated with NODM in men. Compared to the high-stable trajectory, downward had greater associations than upward mobility. In women, when considering metabolic syndrome-related variables, changes in social hierarchy did not seem to have an influence on their risk of diabetes.
  
  
  
  Accumulation of risk and social mobility were associated with NODM with gender-specific patterns, suggesting differences in mechanisms connecting life-course socioeconomic position and diabetes in men and women.
authors.affiliation: Postgraduate Program in Public Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Lidyane V
authors.initials: LV
authors.lastname: Camelo
authors.affiliation: Postgraduate Program in Public Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Luana
authors.initials: L
authors.lastname: Giatti
authors.affiliation: Postgraduate Program in Epidemiology and Hospital de Clinicas de Porto Alegre, Universidade Federal Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Duncan
authors.affiliation: Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Dóra
authors.initials: D
authors.lastname: Chor
authors.affiliation: Laboratory of Health and Environment Education, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Rosane Härter
authors.initials: RH
authors.lastname: Griep
authors.affiliation: Postgraduate Program in Epidemiology and Hospital de Clinicas de Porto Alegre, Universidade Federal Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Maria Inês
authors.initials: MI
authors.lastname: Schmidt
authors.affiliation: Postgraduate Program in Public Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. Electronic address: sbarreto@medicina.ufmg.br.
authors.forename: Sandhi Maria
authors.initials: SM
authors.lastname: Barreto
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002322:Career Mobility; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012923:Social Class; D012937:Social Mobility
keywords: Diabetes; Health inequalities; Life-course epidemiology; Social mobility