Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jun;70(6):596-601.
doi: 10.1136/jech-2015-206702. Epub 2015 Dec 17.

Socioeconomic Status, Comorbidity and Mortality in Patients With Type 2 Diabetes Mellitus in Scotland 2004-2011: A Cohort Study

Affiliations
Free PMC article

Socioeconomic Status, Comorbidity and Mortality in Patients With Type 2 Diabetes Mellitus in Scotland 2004-2011: A Cohort Study

Jeremy Walker et al. J Epidemiol Community Health. .
Free PMC article

Abstract

Background: Mortality in people with and without diabetes often exhibits marked social patterning, risk of death being greater in deprived groups. This may reflect deprivation-related differences in comorbid disease (conditions additional to diabetes itself). This study sought to determine whether the social patterning of mortality in a population with type 2 diabetes mellitus (T2DM) is explained by differential comorbidity.

Methods: Hospital records for 70 197 men and 56 451 women diagnosed with T2DM at 25 years of age and above in Scotland during the period 2004-2011 were used to construct comorbidity histories. Sex-specific logistic models were fitted to predict mortality at 1 year after diagnosis with T2DM, predicted initially by age and socioeconomic status (SES) then extended to incorporate in turn 5 representations of comorbidity (including the Charlson Index). The capacity of comorbidity to explain social mortality gradients was assessed by observing the change in regression coefficients for SES following the addition of comorbidity.

Results: After adjustment for age and Charlson Index, the OR for the contrast between the least deprived and most deprived quintiles of SES for men was 0.79 (95% CI 0.67 to 0.94). For women, the OR was 0.81 (0.67 to 0.97). Similar results were obtained for the 4 other comorbidity measures used.

Conclusions: The social patterning of mortality in people with T2DM is not fully explained by differing levels of comorbid disease additional to T2DM itself. Other dimensions of deprivation are implicated in the elevated death rates observed in deprived groups of people with T2DM.

Keywords: DEPRIVATION; DIABETES; EPIDEMIOLOGY.

Figures

Figure 1
Figure 1
OR estimates for the association between socioeconomic status (Scottish Index of Multiple Deprivation (SIMD) quintile) and 1-year mortality in men, adjusted for age only (no comorbidity) and for age plus five representations of comorbidity. Estimates are expressed relative to reference category SIMD quintile 1 (most deprived). Dashed horizontal line marks OR of unity (‘no association’).
Figure 2
Figure 2
OR estimates for the association between socioeconomic status (Scottish Index of Multiple Deprivation (SIMD) quintile) and 1-year mortality in women, adjusted for age only (no comorbidity) and for age plus five representations of comorbidity. Estimates are expressed relative to reference category SIMD quintile 1 (most deprived). Dashed horizontal line marks OR of unity (‘no association’).

Similar articles

See all similar articles

Cited by 8 articles

See all "Cited by" articles

References

    1. Nwaneri C, Cooper H, Bowen-Jones D. Mortality in type 2 diabetes mellitus: magnitude of the evidence from a systematic review and meta-analysis. Br J Diabetes Vasc Dis 2013;13:192–207. 10.1177/1474651413495703 - DOI
    1. Hu FB, Stampfer MJ, Solomon CG, et al. The impact of diabetes mellitus on mortality from all causes and coronary heart disease in women. Arch Intern Med 2001;161:1717–23. 10.1001/archinte.161.14.1717 - DOI - PubMed
    1. Lotufo PA, Gaziano JM, Chae CU, et al. Diabetes and all-cause and coronary heart disease mortality among US male physicians. Arch Intern Med 2001;161:242–7. 10.1001/archinte.161.2.242 - DOI - PubMed
    1. Robinson N, Lloyd CE, Stevens LK. Social deprivation and mortality in adults with diabetes mellitus. Diabet Med 1998;15:205–12. 10.1002/(SICI)1096-9136(199803)15:3<205::AID-DIA519>3.0.CO;2-# - DOI - PubMed
    1. Roper NA, Bilous RW, Kelly WF, et al. Excess mortality in a population with diabetes and the impact of material deprivation: longitudinal, population based study. BMJ 2001;322:1389–93. 10.1136/bmj.322.7299.1389 - DOI - PMC - PubMed

Publication types

Feedback