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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 2018

See all articles by Hongjiang Wu

Hongjiang Wu

University of Edinburgh

Fiona Bragg

University of Oxford

Ling Yang

University of Oxford

Huaidong Du

University of Oxford - Medical Research Council Population Health Research Unit (MRC PHRU)

Yu Guo

Chinese Academy of Medical Sciences

Caroline A. Jackson

University of Edinburgh

Shankuan Zhu

Zhejiang University

Canqing Yu

Peking University - Department of Epidemiology and Biostatistics

Andrea Oy Luk

The Chinese University of Hong Kong (CUHK)

Juliana Chan

The Chinese University of Hong Kong (CUHK)

Danijela Gasevic

University of Edinburgh

Liming Li

Chinese Academy of Medical Sciences

Zhengming Chen

University of Oxford - Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU)

Sarah Wild

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics

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Abstract

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.

Suggested Citation

Wu, Hongjiang and Bragg, Fiona and Yang, Ling and Du, Huaidong and Guo, Yu and Jackson, Caroline A. and Zhu, Shankuan and Yu, Canqing and Oy Luk, Andrea and Chan, Juliana and Gasevic, Danijela and Li, Liming and Chen, Zhengming and Wild, Sarah, Sex Difference in Association between Socioeconomic Status and Diabetes Prevalence and Incidence in China: Cross-Sectional and Prospective Studies of 0·5 Million Adults (August 21, 2018). Available at SSRN: https://ssrn.com/abstract=3237013

Hongjiang Wu

University of Edinburgh

Old College
South Bridge
Edinburgh, Scotland EH8 9JY
United Kingdom

Fiona Bragg

University of Oxford

Mansfield Road
Oxford, Oxfordshire OX1 4AU
United Kingdom

Ling Yang

University of Oxford

Mansfield Road
Oxford, Oxfordshire OX1 4AU
United Kingdom

Huaidong Du

University of Oxford - Medical Research Council Population Health Research Unit (MRC PHRU)

Oxford
United Kingdom

Yu Guo

Chinese Academy of Medical Sciences

NO. 9, Dongdan Santiao
Beijing, Dongcheng District
China

Caroline A. Jackson

University of Edinburgh

Old College
South Bridge
Edinburgh, Scotland EH8 9JY
United Kingdom

Shankuan Zhu

Zhejiang University

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Canqing Yu

Peking University - Department of Epidemiology and Biostatistics ( email )

No. 38 Xueyuan Road
Haidian District
Beijing, Beijing 100871
China

Andrea Oy Luk

The Chinese University of Hong Kong (CUHK)

Shatin, N.T.
Hong Kong
Hong Kong

Juliana Chan

The Chinese University of Hong Kong (CUHK)

Shatin, N.T.
Hong Kong
Hong Kong

Danijela Gasevic

University of Edinburgh

Old College
South Bridge
Edinburgh, Scotland EH8 9JY
United Kingdom

Liming Li

Chinese Academy of Medical Sciences

NO. 9, Dongdan Santiao
Beijing, Dongcheng District
China

Zhengming Chen

University of Oxford - Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU)

Richard Doll Building
Old Road Campus
Oxford, OX3 7LF
United Kingdom

Sarah Wild (Contact Author)

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics ( email )

Teviot Place
Edinburgh, EH8 9AG
United Kingdom

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