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. 2010 Jun;33(6):1200-5.
doi: 10.2337/dc09-2094. Epub 2010 Mar 3.

Educational disparities in mortality among adults with diabetes in the U.S

Rosemary Dray-Spira  1 , Tiffany L Gary-Webb, Frederick L Brancati
Affiliations

Educational disparities in mortality among adults with diabetes in the U.S

Rosemary Dray-Spira et al. Diabetes Care. 2010 Jun.

Abstract

Objective: To measure relative and absolute educational disparities in mortality among U.S. adults with diabetes and to compare their magnitude with disparities observed within the nondiabetic population.

Research design and methods: A total of 85,867 individuals (5,007 with diabetes), aged 35-84 years, who participated in the National Health Interview Survey from 1986 to 1996 were followed for mortality through 31 December 2002. Relative and absolute educational disparities in all-cause, cardiovascular disease (CVD), and non-CVD mortality were measured.

Results: In relative terms, the risk of all-cause mortality was 28% higher in diabetic adults with the lowest versus the highest position on the educational scale (relative index of inequality 1.28 [95% CI 1.08-1.53]). This inverse relationship reflected marked disparities in CVD mortality and was found in all age, sex, and race/ethnicity groups except Hispanics. Although substantial, this relative educational gradient in mortality among adults with diabetes was smaller than in the nondiabetic population. In absolute terms, diabetic adults with the lowest position on the educational scale suffered 503 excess deaths per 10,000 person-years of follow-up compared with those with the highest position. These absolute disparities were stronger than in the nondiabetic population. The results were even more striking for CVD mortality.

Conclusions: The risk of mortality differs substantially according to educational level among individuals with diabetes in the U.S. Although relative educational disparities in mortality are weaker in adults with versus without diabetes, their absolute impact is greater and translates into a major mortality burden.

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Figures

Figure 1
Figure 1
Age- and sex-standardized all-cause, CVD, and non-CVD mortality rates (95% CIs) according to educational level among adults with and without diabetes.
Figure 2
Figure 2
Relative index of inequality (adjusted for survey year and, if appropriate, for age, sex, and race/ethnicity) (95% CIs) in all-cause, CVD, and non-CVD mortality among adults with diabetes by age (A), sex (B), and race/ethnicity (C).
See this image and copyright information in PMC

References

    1. Engelgau MM, Geiss LS, Saaddine JB, Boyle JP, Benjamin SM, Gregg EW, Tierney EF, Rios-Burrows N, Mokdad AH, Ford ES, Imperatore G, Narayan KM: The evolving diabetes burden in the United States. Ann Intern Med 2004;140:945–950 - PubMed
    1. Wild S, Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047–1053 - PubMed
    1. Diabetes Atlas. 3rd ed Brussels, Belgium, International Diabetes Federation, 2006.
    1. Cowie C, Eberhardt M: Sociodemographic characteristics of persons with diabetes. In Diabetes in America. 2nd ed Harris M, Cowie C, Stern M, National Diabetes Data Group , Eds. Washington, DC, U.S. Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases, 1995. p. 85–116
    1. Espelt A, Borrell C, Roskam AJ, Rodriguez-Sanz M, Stirbu I, Dalmau-Bueno A, Regidor E, Bopp M, Martikainen P, Leinsalu M, Artnik B, Rychtarikova J, Kalediene R, Dzurova D, Mackenbach J, Kunst AE: Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century. Diabetologia 2008;51:1971–1979 - PubMed

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