Associations between socioeconomic status and major complications in type 1 diabetes: the Pittsburgh epidemiology of diabetes complication (EDC) study
Open accessAbstract
Purpose To understand the effect of socioeconomic status (SES) on the risk of complications in type 1 diabetes (T1D), we explored the relationship between SES and major diabetes complications in a prospective, observational T1D cohort study.Methods Complete data were available for 317 T1D persons within 4 years of age 28 (ages 24-32) in the Pittsburgh Epidemiology of Diabetes Complications Study. Age 28 was selected to maximize income, education, and occupation potential and to minimize the effect of advanced diabetes complications on SES.Results The incidences over 1 to 20 years' follow-up of end-stage renal disease and coronary artery disease were two to three times greater for T1D individuals without, compared with those with a college degree (p < .05 for both), whereas the incidence of autonomic neuropathy was significantly greater for low-income and/or nonprofessional participants (p < .05 for both). HbA(1c) was inversely associated only with income level. In sex- and diabetes duration-adjusted Cox models, lower education predicted end-stage renal disease (hazard ratio [HR], 2.9; 95% confidence interval [95% CI], 1.1-7.7) and coronary artery disease (HR, 2.5, 95% CI, 1.3-4.9), whereas lower income predicted autonomic neuropathy (HR, 1.7; 95% CI, 1.0-2.9) and lower-extremity arterial disease (HR, 3.7; 95% CI, 1.1-11.9).Conclusions These associations, partially mediated by clinical risk factors, suggest that lower SES T1D individuals may have poorer self-management and, thus, greater complications from diabetes.
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Research has found further non-glycaemic factors that raise complication risk.
“Several studies127–130 have identified additional non-glycaemic risk factors for the development of complications.”
From Type 1 diabetes (2018) · cites this paper as [127]
Lower education and income are linked to higher risks of both microvascular and macrovascular complications.
“Low levels of education and income have been associated with high risks of both micro-vascular and macrovascular complications.127”
From Type 1 diabetes (2018) · cites this paper as [127]
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- Authors
- Secrest, A. M., Costacou, T., Gutelius, B., Miller, R. G., Songer, T. J., & Orchard, T. J.
- Affiliations
- University of Pittsburgh (US)
- New York City Department of Health and Mental Hygiene (US)
- Corresponding author
- Orchard, Trevor J.
- Venue
- Annals of Epidemiology
- Publisher
- Elsevier BV
- Published
- 2011-05
- Volume
- 21
- Issue
- 5
- Pages
- 374-381
- ISSN
- 1047-2797 (ISSN-L)
- PMC
- PMC3079455
- OpenAlex
- W2148414695
- Cited by
- 144
- References
- 27
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 12 · 2023: 7 · 2022: 11 · 2021: 15 · 2020: 13 · 2019: 12 · 2018: 13 · 2017: 9 · 2016: 7 · 2015: 12 · 2014: 7 · 2013: 7 · 2012: 9
- FWCI
- 6.03
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R37DK034818, R01DK034818, F30DK082137)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- type 1 diabetes, socioeconomic status, diabetes complications, end-stage renal disease, coronary artery disease, autonomic neuropathy, lower extremity arterial disease, educational attainment, income, HbA1c, diabetes self-management, Pittsburgh Epidemiology of Diabetes Complications Study
- MeSH terms
- Adolescent, Adult, Diabetes Mellitus, Type 1, Employment, Female, Humans, Male, Pennsylvania, Prospective Studies, Social Class, Cohort Studies, Confidence Intervals, Diabetes Complications, Young Adult
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