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Diabetes Outcomes Strongly Influenced by Income and Education

CardioSmart News

Even with the same access to care, poor individuals with type 2 diabetes have greater risk of death than those with higher income and education, according to a recent analysis of a Swedish diabetes registry.

Published in JAMA Internal Medicine, this study looked at the impact of socioeconomic status on survival rates for type 2 diabetes. Socioeconomic status includes factors like education, income and occupation, which tend to have an underlying impact on health. However, most diabetes prevention efforts address health-related risk factors such as obesity and inactivity. Experts worry that we’re overlooking potential increased risk linked to income and education.

To learn more, researchers analyzed data from the Sweden National Diabetes Register, which includes more than 217,000 Swedish adults with type 2 diabetes. Participants were enrolled between 2003 and 2010, and outcomes were recorded through the end of 2012.

Over the study period, there were a total of 19,105 deaths, with nearly 60% of those deaths related to heart disease. However, individuals who were single, had lower levels of education and lower income had significantly greater risk of death than those with higher socioeconomic status.

After taking into account factors like access to care, married adults with diabetes had 27% lower risk of death from all causes than their single counterparts. Having a college degree was associated with a 15% lower risk of all-cause mortality compared to individuals with nine years or less of education. And compared to individuals in the highest income bracket, adults with the lowest income had anywhere from 71–87% greater risk of all-cause cardiovascular and diabetes-related deaths. Risk of cancer-related deaths was also greater in low-income adults with diabetes, although the association was not as strong.

Based on findings, authors highlight the need to address socioeconomic disadvantages for diabetes prevention. Today, roughly half of adults in the United States have diabetes or have prediabetes, which puts them at increased risk for developing this condition. While diabetes prevention is a major focus of public health efforts, most education is on established risk factors for diabetes, like obesity, poor diet and inactivity. Based on recent findings, it’s clear that socioeconomic risk factors also play a large role in diabetes outcomes. By addressing underlying risk factors and providing additional support to disadvantaged populations, experts hope to better prevent and improve outcomes related to diabetes.

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