Socioeconomic status and risk of diabetes-related mortality in the U.S

Public Health Rep. 2010 May-Jun;125(3):377-88. doi: 10.1177/003335491012500306.


Objective: We examined disparities in diabetes-related mortality for socioeconomic status (SES) groups in nationally representative U.S. samples.

Methods: We analyzed National Health Interview Survey respondents linked to their death records and included those eligible for mortality follow-up who were aged 25 years and older at the time of interview and not missing information on covariates (n=527,426). We measured SES by education and family income. There were 5,613 diabetes-related deaths.

Results: Having less than a high school education was associated with a twofold higher mortality from diabetes, after controlling for age, gender, race/ethnicity, marital status, and body mass index, compared with adults with a college degree or higher education level (relative hazard [RH] = 2.05, 95% confidence interval [CI] 1.78, 2.35). Having a family income below poverty level was associated with a twofold higher mortality after adjustments compared with adults with the highest family incomes (RH=2.41, 95% CI 2.05, 2.84). Approximately one-quarter of the excess risk among those in the lowest SES categories was explained by adjusting for potential confounders.

Conclusion: Findings from this nationally representative cohort demonstrate a socioeconomic gradient in diabetes-related mortality, with both education and income being important determinants of the risk of death.

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Diabetes Mellitus / mortality*
  • Educational Status
  • Female
  • Health Status Disparities*
  • Humans
  • Income
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Risk Factors
  • Social Class*
  • United States / epidemiology