Socioeconomic Status and Cardiovascular Risk Control in Adults With Diabetes

Abstract

OBJECTIVE To examine the association between subjective (SSS) and objective (OSS) social status and cardiovascular disease (CVD) risk factors in adults with type 2 diabetes. METHODS Adult study participants (N=358) were recruited from 2 primary care settings. CVD risk factors included hemoglobinA1c (HbA1c), systolic (SBP) and diastolic (DBP) blood pressure and low-density lipoprotein-cholesterol (LDL-C). Objective social status was assessed by income, education and employment. Subjective social status was measured using the validated MacArthur Scales of Subjective Social Status to demarcate self-reported perceptions of having the most money, education, and respected job using a ladder scale (1=rung 1, 10=rung 10). Multiple linear regression was used to examine associations between CVD risk factors and subjective and objective social status controlling for age, gender, race/ethnicity, marital status, employment status, income, study site, comorbidity, education, and insurance status. RESULTS Fully adjusted models showed that rung 2 (p=0.029), rung 3 (p=0.032), rung 8 (p=0.049), and rung 9 (p=0.032) of the subjective social status were significantly associated with poorer DBP. Annual income ≥ $75, 000 was significantly associated with lower LDL-C (p=0.021). Employment was associated with lower HbA1c (p=0.036), but higher LDL-C (p=0.002). CONCLUSIONS Subjective and objective social status levels are differentially associated with HbA1c, DBP, and LDL-C. Findings provide new information about patients’ perspectives of the relationship between social status and diabetes-related outcomes.

Socio‐economic status and HbA1c in type 2 diabetes: A systematic review and meta‐analysis

“…After screening the titles and abstracts of all references, 262 potentially eligible articles were read full text. Fifty‐five studies met the inclusion criteria of this review . As 2 studies examined identical associations within the same sample, we only included 1 paper in our study .…”

“…Education was the most often studied SES variable; 32 studies reported on the association between education and HbA 1c levels . A random‐effects meta‐analysis of 10 studies revealed that people with the lowest educational level had a 0.26% (95% CI, 0.09‐0.43) or 3.12 mmol/mol (95% CI, 1.21‐5.04) higher mean HbA 1c level, compared with people with the highest educational level.…”

“…There were 8 studies on the association between employment status and HbA 1c levels . Quantitative data synthesis was not performed due to low number of studies (2 studies).…”

Association between sociodemographic determinants and health outcomes in individuals with type 2 diabetes in Sweden

“…The relationship between social determinants of health and health outcomes has been established but is not well understood . Previous literature point to differences in diabetes care between sociodemographic groups in differences in HbA 1c , CVD risk, low‐density lipoprotein (LDL) cholesterol and blood pressure . In addition, a large Swedish study based on the National Diabetes Register (NDR) showed that socioeconomic status (country of birth, education, income, marital status, and occupation) was a strong predictor of both cardiovascular and diabetes‐related mortality .…”

“…5 Previous literature point to differences in diabetes care between sociodemographic groups in differences in HbA 1c , CVD risk, low-density lipoprotein (LDL) cholesterol and blood pressure. [5][6][7] In addition, a large Swedish study based on the National Diabetes Register (NDR) showed that socioeconomic status (country of birth, education, income, marital status, and occupation) was a strong predictor of both cardiovascular and diabetes-related mortality. 8 Most of the studies conducted so far, however, focused on only 1 risk factor (mainly glycaemic control) even if concurrent multifactorial treatment is needed to reduce consequent risks of diabetes.…”