IJE Advance Access originally published online on August 24, 2005
International Journal of Epidemiology 2005 34(6):1274-1281; doi:10.1093/ije/dyi167
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Education, income, occupation, and the 34-year incidence (1965–99) of Type 2 diabetes in the Alameda County Study
1 School of Community Health, Portland State University, PO Box 751, Portland, OR 97207-0751, USA
2 Department of Preventive Medicine and Behavioral Sciences, Rush Institute for Health Aging, Rush University Medical Center, 1700 West Van Buren Street, Chicago, IL 60612-3291, USA
3 Department of Epidemiology, University of Michigan, 109 Observatory Street, Ann Arbor, MI 48109-2029, USA
4 Center for Social Epidemiology and Population Health, University of Michigan, 1214 S. University, Ann Arbor, MI 48104-2548, USA
5 Department of Biostatistics, University of Michigan, 109 Observatory Street, Ann Arbor, MI 48109-2029, USA
* Corresponding author. School of Community Health, College of Urban and Public Affairs, Portland State University, PO Box 751, Portland, OR 97207-0751, USA. E-mail: maty{at}pdx.edu
Background Lower socioeconomic position (SEP) is related to higher prevalence of Type 2 diabetes, yet little is known about the relationship of SEP with incident diabetes.
Methods The association between SEP, measured by self-reported education, income, and occupation, and Type 2 diabetes incidence was examined in a community sample of 6147 diabetes-free adults from Alameda County, CA. Cox proportional hazards models estimated the effect of baseline (1965) and time-dependent (value changes over time) measures of SEP on incident diabetes over a 34-year study period (1965–99). Demographic confounders (age, gender, race, and marital status) and potential components of the causal pathway (physical inactivity, smoking, alcohol consumption, body composition, hypertension, depression, and health care access) were included as fixed or time-dependent covariates.
Results Education, income, and occupation were associated with increased diabetes risk in unadjusted models. In baseline models adjusted for demographics, respondents with <12 years of education had 50% excess risk compared with those with more education [hazard ratio (HR) = 1.5, 95% confidence interval (95% CI) 1.11–2.04], but income and occupation were no longer significantly associated with increased risk. Further adjustment minimized the significance of all associations. Time-dependent effects were consistently elevated for low education and male blue-collar occupation, but non-significant after full adjustment (HR = 1.1, 95% CI 0.79–1.47 and HR = 1.3, 95% CI 0.91–1.89, respectively).
Conclusions Socioeconomic disadvantage, especially with low educational attainment, is a significant predictor of incident Type 2 diabetes, although associations were largely eliminated after covariate adjustment. Obesity and overweight appear to mediate these associations.
Keywords Socioeconomic factors, Type 2 diabetes mellitus, incidence
Accepted 25 July 2005
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