Lifecourse Socioeconomic Position, Race and Prevalence of Diabetes among US Women and Men

Few studies have examined the degree to which a lifecourse perspective on socioeconomic position (SEP) accounts for Black-White differences in the development of diabetes. This question was addressed in data from the Americans' Changing Lives study of 3,497 adults aged 25 years and older. Sex-specific generalized estimating equations were used to compute prevalence ratios (PR) for associations of race and SEP with self-reported diagnoses of diabetes recorded at four waves of data collection during the 16 year study period (1986-2002). For men, childhood and adult SEP were unrelated to prevalence of diabetes and adjustment for lifecourse SEP had little effect on the excess prevalence of diabetes in Blacks (PR=1.56, 95%CI: 1.11, 2.21). In contrast, low father and low respondent education were each associated with increased diabetes in women (PR=1.69, 95%CI: 1.08, 2.63 and 1.78, 95%CI: 1.26, 2.51, respectively) and the combination of low SEP as a child and adult was associated with nearly a threefold increase (PR=2.89, 95%CI: 2.10, 3.99) in the prevalence of diabetes. The adjustment for lifecourse SEP reduced the PR for the association between race and diabetes in women from 1.96 (95%CI: 1.52, 2.54) to 1.40 (95%CI: 1.04, 1.87). The results suggest that the pathway and cumulative hypotheses for lifecourse SEP effects on diabetes may be especially salient for women.