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Association of socioeconomic status with mortality in type 1 diabetes: the Pittsburgh epidemiology of diabetes complications study.

ABSTRACT: Socioeconomic status (SES) as a risk factor for mortality in type 1 diabetes (T1D) has not been adequately studied prospectively.Complete clinical and SES (income, education, occupation) data were available for 317 T1D participants in the Pittsburgh Epidemiology of Diabetes Complications Study within 4 years of age 28 (chosen to maximize income, education, and occupational potential, and to minimize the SES effect of advanced diabetes complications). Vital status was determined as of 1/1/2008.Over a median 16 years of follow-up, 34 (10.7%) deaths occurred (standardized mortality ratios [SMRs] = 4.1, 95% confidence interval [CI]: 2.7-5.5). SMRs did not differ from the general population for those in the highest education and income groups, whereas in those with low SES, SMRs were increased. Mortality rates were three times lower for individuals with a college degree versus without a college degree (p = 0.004) and nearly four times lower for the highest income versus lower income groups (p = 0.04). In Cox models adjusting for diabetes duration and sex, education was the only SES measure predictive of mortality (hazard ratio [HR] = 3.0, 95% CI: 1.2-7.8), but lost significance after adjusting for HbA(1c), non-HDL cholesterol, hypertension, and microalbuminuria (HR = 2.1, 95% CI: 0.8-5.6).The strong association of education with mortality in T1D is partially mediated by better glycemic, lipid, and blood pressure control.

SUBMITTER: Secrest AM

PROVIDER: S-EPMC3070912 | biostudies-literature | 2011 May

REPOSITORIES: biostudies-literature

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Association of socioeconomic status with mortality in type 1 diabetes: the Pittsburgh epidemiology of diabetes complications study.

Secrest Aaron M AM Costacou Tina T Gutelius Bruce B Miller Rachel G RG Songer Thomas J TJ Orchard Trevor J TJ

Annals of epidemiology 20110501 5

<h4>Purpose</h4>Socioeconomic status (SES) as a risk factor for mortality in type 1 diabetes (T1D) has not been adequately studied prospectively.<h4>Methods</h4>Complete clinical and SES (income, education, occupation) data were available for 317 T1D participants in the Pittsburgh Epidemiology of Diabetes Complications Study within 4 years of age 28 (chosen to maximize income, education, and occupational potential, and to minimize the SES effect of advanced diabetes complications). Vital status ...[more]

PMID: 21458730

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Project description:BACKGROUND:Clinical treatment goals of type 1 diabetes mellitus (T1DM) have changed since the Diabetes Control and Complications Trial (DCCT) demonstrated reduced long-term complications with intensive diabetes therapy. There have been few longitudinal studies to describe the clinical course of T1DM in the age of intensive therapy. Our objective was to describe the current-day clinical course of T1DM. METHODS:An analysis of the cumulative incidence of long-term complications was performed. The DCCT (1983-1993) assigned patients to conventional or intensive therapy. Since 1993, the DCCT has been observational, and intensive therapy was recommended for all patients. The Pittsburgh Epidemiology of Diabetes Complications (EDC) study is an observational study of patients with T1DM from Allegheny County, Pennsylvania. The study population comprised the DCCT T1DM cohort (N = 1441) and a subset of the EDC cohort (n = 161) selected to match DCCT entry criteria. In the DCCT, intensive therapy aimed for a near-normal glycemic level with 3 or more daily insulin injections or an insulin pump. Conventional therapy, with 1 to 2 daily insulin injections, was not designed to achieve specific glycemic targets. Main outcome measures included the incidences of proliferative retinopathy, nephropathy (albumin excretion rate >300 mg/24 h, creatinine level >or=2 mg/dL [to convert to micromoles per liter, multiply by 88.4], or renal replacement), and cardiovascular disease. RESULTS:After 30 years of diabetes, the cumulative incidences of proliferative retinopathy, nephropathy, and cardiovascular disease were 50%, 25%, and 14%, respectively, in the DCCT conventional treatment group, and 47%, 17%, and 14%, respectively, in the EDC cohort. The DCCT intensive therapy group had substantially lower cumulative incidences (21%, 9%, and 9%) and fewer than 1% became blind, required kidney replacement, or had an amputation because of diabetes during that time. CONCLUSION:The frequencies of serious complications in patients with T1DM, especially when treated intensively, are lower than that reported historically.

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Association of socioeconomic status with mortality in type 1 diabetes: the Pittsburgh epidemiology of diabetes complications study.

Publications

Association of socioeconomic status with mortality in type 1 diabetes: the Pittsburgh epidemiology of diabetes complications study.

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