The 130th Annual Meeting of APHA

Abstract #47176

Siobhan C. Maty, MPH¹, Susan A. Everson, PhD, MPH², Jennifer L. Balfour, PhD, MPH¹, Trivellore E. Raghunathan, PhD³, and George A. Kaplan, PhD⁴. (1) Department of Epidemiology/Center for Social Epidemiology and Population Health, University of Michigan, 1214 S. University, 2nd Floor, Ann Arbor, MI 48104, 734-615-0696, smaty@umich.edu, (2) Dept. of Preventive Medicine, Rush-Presbyterian-St. Luke's Medical Center, 1700 West Van Buren St., Suite 470, Chicago, IL 60612, (3) Biostatistics, University of Michigan, M4218 Sph II, Ann Arbor, MI 48109, (4) Epidemiology, University of Michigan, 1010 Sph I, Ann Arbor, MI 48109

Lower socioeconomic position (SEP) is related to higher prevalence of Type 2 diabetes. Little is known about the relationship of SEP and diabetes incidence. Adult SEP and diabetes incidence were measured over 34 years in 6,147 adults from Alameda County, CA. SEP was assessed using years of education, log household income and occupational category. Cox proportional hazard models were used to estimate the risk of incident diabetes from 1965 to 1999 with both SEP and covariates as fixed and time-dependent risk factors. Covariates included measures of demographics, hypertension, depression, body composition, behavior, and health care access. Education, income and occupation were associated with increased risk of diabetes, reduced by adjustment for other covariates, particularly body mass index. In a time-dependent model for each SEP indicator with adjustment for all covariates, the relative hazards (95% confidence intervals) were as follows: <12 years education=2.11(1.56, 2.85) and 12 years of education=1.56(1.18, 2.05) vs. >12 years of education; log income=0.84(0.74, 0.96); blue-collar occupation=1.44(1.10,1.88) vs. white-collar men and blue-collar=1.37(0.98,1.93) vs. white-collar occupation women. Compared to models using baseline measures, the more proximal effects of SEP on diabetes risk were stronger and more robust. When all three SEP measures were entered simultaneously, only education remained significant. Adult SEP is a robust predictor of incident Type 2 diabetes. Education has the strongest effect on disease development. Although residual confounding is possible, the results suggest that non-traditional risk factors may be in the pathways linking SEP and diabetes incidence.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Describe Type 2 diabetes and its related public health burden in lower-socioeconomic groups
• Assess how education, income and occupation influence the development of Type 2 diabetes in adults over time
• Recognize how the timing and method of measurement of socioeconomic factors (education, income and occupation) can influence their observed associations with diabetes incidence

Keywords: Diabetes, Social Inequalities

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.