Area-based socioeconomic status, type 2 diabetes and cardiovascular mortality in Scotland - PubMed (original) (raw)

. 2012 Nov;55(11):2938-45.

doi: 10.1007/s00125-012-2667-1. Epub 2012 Aug 15.

N R V Jones, J J Walker, C M Fischbacher, H M Colhoun, G P Leese, R S Lindsay, J A McKnight, A D Morris, J R Petrie, N Sattar, S H Wild; Scottish Diabetes Research Network Epidemiology Group

Collaborators, Affiliations

Area-based socioeconomic status, type 2 diabetes and cardiovascular mortality in Scotland

C A Jackson et al. Diabetologia. 2012 Nov.

Abstract

Aims/hypothesis: The aim of this study was to explore the relationships between type 2 diabetes mellitus, area-based socioeconomic status (SES) and cardiovascular disease mortality in Scotland.

Methods: We used an area-based measure of SES, Scottish national diabetes register data linked to mortality records, and general population cause-specific mortality data to investigate the relationships between SES, type 2 diabetes and mortality from ischaemic heart disease (IHD) and cerebrovascular disease (CbVD), for 2001-2007. We used negative binomial regression to obtain age-adjusted RRs of mortality (by sex), comparing people with type 2 diabetes with the non-diabetic population.

Results: Among 216,652 people aged 40 years or older with type 2 diabetes (980,687 person-years), there were 10,554 IHD deaths and 4,378 CbVD deaths. Age-standardised mortality increased with increasing deprivation, and was higher among men. IHD mortality RRs were highest among the least deprived quintile and lowest in the most deprived quintile (men: least deprived, RR 1.94 [95% CI 1.61, 2.33]; most deprived, RR 1.46 [95% CI 1.23, 1.74]) and were higher in women than men (women: least deprived, RR 2.84 [95% CI 2.12, 3.80]; most deprived, RR 2.04 [95% CI 1.55, 2.69]). A similar, weaker, pattern was observed for cerebrovascular mortality.

Conclusions/interpretation: Absolute risk of cardiovascular mortality is higher in people with diabetes than in the non-diabetic population and increases with increasing deprivation. The relative impact of diabetes on cardiovascular mortality differs by SES, and further efforts to reduce cardiovascular risk both in deprived groups and people with diabetes are required. Prevention of diabetes may reduce socioeconomic health inequalities.

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Figures

Figure 1

Figure 1. Age-standardised ischaemic heart disease mortality rates by socioeconomic status, for men and women with and without type 2 diabetes

White circles, people without diabetes; Black squares, people with type 2 diabetes mellitus SIMD = Scottish index of multiple deprivation; IHD = ischaemic heart disease; T2DM= type 2 diabetes mellitus

Figure 2

Figure 2. Age-standardised cerebrovascular disease mortality rates by socioeconomic status, for men and women with and without type 2 diabetes

White circles, people without diabetes; Black squares, people with type 2 diabetes mellitus SIMD = Scottish index of multiple deprivation; CbVD = cerebrovascular disease; T2DM= type 2 diabetes mellitus

Figure 3

Figure 3. Contribution to age-adjusted relative risk of ischaemic heart disease from type 2 diabetes, SES and effect modification of diabetes by SES, comparing quintile 5 to quintile 1 for men and women

White block, baseline relative risk; Light grey block, relative risk due to type 2 diabetes; Dark grey block, relative risk due to deprivation; Black block, relative risk due to interaction between deprivation and type 2 diabetes IHD = ischaemic heart disease; T2DM= type 2 diabetes mellitus

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