Life-course socioeconomic position and incidence of diabetes mellitus among blacks and whites: the Alameda County Study, 1965-1999.

OBJECTIVES: We examined associations between several life-course socioeconomic position (SEP) measures (childhood SEP, education, income, occupation) and diabetes incidence from 1965 to 1999 in a sample of 5422 diabetes-free Black and White participants in the Alameda County Study. METHODS: Race-specific Cox proportional hazard models estimated diabetes risk associated with each SEP measure. Demographic confounders (age, gender, marital status) and potential pathway components (physical inactivity, body composition, smoking, alcohol consumption, hypertension, depression, access to health care) were included as covariates. RESULTS: Diabetes incidence was twice as high for Blacks as for Whites. Diabetes risk factors independently increased risk, but effect sizes were greater among Whites. Low childhood SEP elevated risk for both racial groups. Protective effects were suggested for low education and blue-collar occupation among Blacks, but these factors increased risk for Whites. Income was protective for Whites but not Blacks. Covariate adjustment had negligible effects on associations between each SEP measure and diabetes incidence for both racial groups. CONCLUSIONS: These findings suggest an important role for life-course SEP measures in determining risk of diabetes, regardless of race and after adjustment for factors that may confound or mediate these associations.

Childhood socioeconomic position, gender, adult body mass index, and incidence of type 2 diabetes mellitus over 34 years in the Alameda County Study.

OBJECTIVES: We examined the association between childhood socioeconomic position and incidence of type 2 diabetes and the effects of gender and adult body mass index (BMI). METHODS: We studied 5913 participants in the Alameda County Study from 1965 to 1999 who were diabetes free at baseline (1965). Cox proportional hazards models estimated diabetes risk associated with childhood socioeconomic position and combined childhood socioeconomic position-adult BMI categories in pooled and gender-stratified samples. Demographic confounders and potential pathway components (physical inactivity, smoking, alcohol consumption, hypertension, depression, health care access) were included as covariates. RESULTS: Low childhood socioeconomic position was associated with excess diabetes risk, especially among women. Race and body composition accounted for some of this excess risk. The association between childhood socioeconomic position and diabetes incidence differed by adult BMI category in the pooled and women-only groups. Adjustment for race and behaviors attenuated the risk attributable to low childhood socioeconomic position among the obese group only. CONCLUSIONS: Childhood socioeconomic position was a robust predictor of incident diabetes, especially among women. A cumulative risk effect was observed for both childhood socioeconomic position and adult BMI, especially among women.

Education, income, occupation, and the 34-year incidence (1965-99) of Type 2 diabetes in the Alameda County Study.

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.

Patterns of disability related to diabetes mellitus in older women.

PURPOSE: To identify pattern(s) of disability related to diabetes in older women and to determine the extent to which disability is mediated by selected diabetes complications. METHODS: Cross-sectional analysis of data from a population-based study composed of a representative sample of 3570 noninstitutionalized women aged 65 years and older living in the Baltimore metropolitan area who agreed to be screened for the Women's Health and Aging Study. RESULTS: 483 (13.5%) of the women reported physician-diagnosed diabetes. Compared to women without diabetes, women with diabetes were significantly more likely to report difficulty in 14 of 15 daily tasks, including walking 2-3 blocks, lifting 10 pounds, using the telephone, and bathing (range of odds ratios [OR] 1.5-2.8; all p <.01). After adjustment for age, race, and marital status, women with diabetes were about twice as likely to report difficulty in any one of four functioning groups (mobility, upper extremity, higher functioning tasks, or self-care) (OR 2.2; 95% confidence interval [CI] 1.8-2.7), and over three times as likely to report difficulty in a group combining higher functioning and self-care tasks (OR 3.2; 95% CI 2.4-4.1). Adjustment for self-reported heart disease, stroke, high blood pressure, and visual problems did not attenuate these associations. CONCLUSIONS: Diabetes is strongly associated with a wide range of disabilities in older women. This association does not appear to be mediated by prevalent diabetes complications and risks, heart disease, high blood pressure, stroke, or eye disease. Other complications of diabetes (e.g., neuropathy, peripheral vascular disease) may mediate diabetes-associated disability in older adults.

Epidemiologic evidence for the relation between socioeconomic status and depression, obesity, and diabetes.

Many of the leading causes of death and disability in the United States and other countries are associated with socioeconomic position. The least well-off suffer a disproportionate share of the burden of disease, including depression, obesity, and diabetes. Research suggests that the adverse effects of economic hardship on both mental and physical health and functioning are evident at young ages and persist across the lifecourse. Moreover, these associations are seen across cultures. Data from four large epidemiologic studies on the role of psychological characteristics, social factors, and behaviors in health and disease risk are presented that highlight the striking associations between socioeconomic factors and chronic diseases. Data from these studies demonstrate that the effects of economic disadvantage are cumulative, with the greatest risk of poor mental and physical health seen among those who experienced sustained hardship over time.

Cognitive and physical health of the older populations of England, the United States, and Ireland: international comparability of the Irish Longitudinal Study on Ageing.

This article discusses the contribution that international comparisons of the health and well-being of older people make. The comparability of the "HRS family" of studies that have been modeled on the U.S. Health and Retirement Study (HRS) is discussed. The Irish Longitudinal Study of Ageing (TILDA) is introduced, and the comparability of TILDA data with respect to the HRS family and other studies is described, along with what TILDA will add to international aging research. Data from the 2010 waves of TILDA, HRS and the English Longitudinal Study of Ageing are used to compare the physical and cognitive health of older Irish adults with that of the U.S. and English populations. The study shows that the physical and cognitive health of older people in Ireland is closer to that of their English counterparts than of those in the United States and that similar health inequalities exist in all three countries.

Factors that influence self-reported general health status among different Asian ethnic groups: evidence from the Roadmap to the New Horizon: Linking Asians to Improved Health and Wellness study.

Little is known about the determinants of self-reported general health status among different Asian ethnic subgroups. Using a community-based participatory research approach, we designed, administered, and analyzed a cross-sectional survey of 705 Asians (292 Chinese, 226 Korean, 187 Vietnamese) in the Portland, Oregon region to describe associations between general health status and several sociodemographic and health-related factors in pooled and ethnic-group-stratified samples. Ethnic variation existed in all covariate distributions, except employment, public-service use, language use, health status, visiting healthcare providers, sleep habits, and use of prayer, meditation, yoga or acupuncture. Acculturation measures were strong predictors of poor/fair health in logistic regression models regardless of ethnicity. Ethnic variation in outcome status existed for all remaining covariates. Most health-related research overlooks the heterogeneity within the Asian population. These findings highlight substantial variability in the associations between self-reported general health status and sociodemographic and health-related measures between Asian ethnic groups.