Sex Difference in Association between Socioeconomic Status and Diabetes Prevalence and Incidence in China: Cross-Sectional and Prospective Studies of 0·5 Million Adults
42 Pages Posted: 26 Sep 2018More...
Background: China has undergone rapid socioeconomic transition accompanied by lifestyle changes that are expected to have profound impact on the health of its population. However, there is limited evidence from large nationwide studies about the relevance of socioeconomic status (SES) to risk of diabetes. We describe the associations of two key measures of SES with prevalent and incident diabetes in Chinese men and women.
Methods: The China Kadoorie Biobank study included 0.5 million adults aged 30-79 years recruited from ten diverse areas in China during 2004-08. SES was assessed using the highest educational level attained and annual household income. Prevalent diabetes was identified from self-report and plasma glucose measurements. Incident diabetes was identified from linkage to disease and death registries and national health insurance claim databases. We estimated adjusted odds ratios and hazard ratios (ORs and HRs) for prevalent and incident diabetes associated with SES, using logistic and Cox regression models respectively.
Findings: At baseline, 30066 (5·9%) participants had previously diagnosed (3·1%) or screen-detected (2·8%) diabetes, and a further 9544 (2·0%) had new-onset diabetes during follow-up (median 7 years). Adjusted ORs for prevalent diabetes, comparing highest versus lowest educational level, were 1·21 (95% CIs: 1·09, 1·35) in men and 0·69 (0·63, 0·76) in women, and for incident diabetes, the HRs were 1·27 (1·07, 1·51) and 0·80 (0·67, 0·95), respectively. For household income, the adjusted ORs for prevalent diabetes, comparing highest versus lowest category, were 1·45 (1·34, 1·56) in men and 1·26 (1·19, 1·34) in women, and for incident diabetes, the HRs were 1·36 (1·19, 1·55) and 1·06 (0·95, 1·17), respectively.
Interpretation: Among Chinese adults, the associations between education and diabetes differed qualitatively between men and women, whereas higher household income was positively associated with diabetes in both sexes with a stronger relationship in men than women.
Funding: UK Wellcome Trust, UK Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, Chinese Ministry of Science and Technology, Chinese National Natural Science Foundation.
Declaration of Interest: All authors declare no competing interests.
Ethical Approval: Ethical approval for this study was obtained from the University of Oxford, the Chinese Centre for Disease Control and Prevention, and the local Centres for Disease Control and Prevention in the ten study regions. All participants provided written informed consent.
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