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Educational disparities in mortality among adults with diabetes in the U.S.

Dray-Spira R, Gary-Webb TL, Brancati FL - Diabetes Care (2010)

Bottom Line: This inverse relationship reflected marked disparities in CVD mortality and was found in all age, sex, and race/ethnicity groups except Hispanics.In absolute terms, diabetic adults with the lowest position on the educational scale suffered 503 excess deaths per 10,000 person-years of follow-up compared with those with the highest position.The results were even more striking for CVD mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. rosemary.dray-spira@inserm.fr

ABSTRACT

Objective: To measure relative and absolute educational disparities in mortality among U.S. adults with diabetes and to compare their magnitude with disparities observed within the nondiabetic population.

Research design and methods: A total of 85,867 individuals (5,007 with diabetes), aged 35-84 years, who participated in the National Health Interview Survey from 1986 to 1996 were followed for mortality through 31 December 2002. Relative and absolute educational disparities in all-cause, cardiovascular disease (CVD), and non-CVD mortality were measured.

Results: In relative terms, the risk of all-cause mortality was 28% higher in diabetic adults with the lowest versus the highest position on the educational scale (relative index of inequality 1.28 [95% CI 1.08-1.53]). This inverse relationship reflected marked disparities in CVD mortality and was found in all age, sex, and race/ethnicity groups except Hispanics. Although substantial, this relative educational gradient in mortality among adults with diabetes was smaller than in the nondiabetic population. In absolute terms, diabetic adults with the lowest position on the educational scale suffered 503 excess deaths per 10,000 person-years of follow-up compared with those with the highest position. These absolute disparities were stronger than in the nondiabetic population. The results were even more striking for CVD mortality.

Conclusions: The risk of mortality differs substantially according to educational level among individuals with diabetes in the U.S. Although relative educational disparities in mortality are weaker in adults with versus without diabetes, their absolute impact is greater and translates into a major mortality burden.

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Related in: MedlinePlus

Age- and sex-standardized all-cause, CVD, and non-CVD mortality rates (95% CIs) according to educational level among adults with and without diabetes.
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Figure 1: Age- and sex-standardized all-cause, CVD, and non-CVD mortality rates (95% CIs) according to educational level among adults with and without diabetes.

Mentions: Of 15,351 participants who died, 2,188 (14.0%) had diabetes at baseline. CVD accounted for 46.6% of the causes of death among participants with diabetes versus 40.2% among those without. Major non-CVD causes of death were cancers (17.6% of deaths), diabetes (14.7%), and respiratory conditions (5.9%) among participants with diabetes and cancers (29.7%) and respiratory conditions (10.1%) among those without. All-cause, CVD, and non-CVD mortality rates were 340.0, 150.7, and 189.3 per 10,000 person-years, respectively, in adults with diabetes versus 136.9, 52.1, and 84.8 per 10,000 person-years, respectively, in those without. As shown in Fig. 1, all-cause, CVD, and non-CVD mortality rates were inversely associated with educational level in both adults with and without diabetes.


Educational disparities in mortality among adults with diabetes in the U.S.

Dray-Spira R, Gary-Webb TL, Brancati FL - Diabetes Care (2010)

Age- and sex-standardized all-cause, CVD, and non-CVD mortality rates (95% CIs) according to educational level among adults with and without diabetes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2875423&req=5

Figure 1: Age- and sex-standardized all-cause, CVD, and non-CVD mortality rates (95% CIs) according to educational level among adults with and without diabetes.
Mentions: Of 15,351 participants who died, 2,188 (14.0%) had diabetes at baseline. CVD accounted for 46.6% of the causes of death among participants with diabetes versus 40.2% among those without. Major non-CVD causes of death were cancers (17.6% of deaths), diabetes (14.7%), and respiratory conditions (5.9%) among participants with diabetes and cancers (29.7%) and respiratory conditions (10.1%) among those without. All-cause, CVD, and non-CVD mortality rates were 340.0, 150.7, and 189.3 per 10,000 person-years, respectively, in adults with diabetes versus 136.9, 52.1, and 84.8 per 10,000 person-years, respectively, in those without. As shown in Fig. 1, all-cause, CVD, and non-CVD mortality rates were inversely associated with educational level in both adults with and without diabetes.

Bottom Line: This inverse relationship reflected marked disparities in CVD mortality and was found in all age, sex, and race/ethnicity groups except Hispanics.In absolute terms, diabetic adults with the lowest position on the educational scale suffered 503 excess deaths per 10,000 person-years of follow-up compared with those with the highest position.The results were even more striking for CVD mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. rosemary.dray-spira@inserm.fr

ABSTRACT

Objective: To measure relative and absolute educational disparities in mortality among U.S. adults with diabetes and to compare their magnitude with disparities observed within the nondiabetic population.

Research design and methods: A total of 85,867 individuals (5,007 with diabetes), aged 35-84 years, who participated in the National Health Interview Survey from 1986 to 1996 were followed for mortality through 31 December 2002. Relative and absolute educational disparities in all-cause, cardiovascular disease (CVD), and non-CVD mortality were measured.

Results: In relative terms, the risk of all-cause mortality was 28% higher in diabetic adults with the lowest versus the highest position on the educational scale (relative index of inequality 1.28 [95% CI 1.08-1.53]). This inverse relationship reflected marked disparities in CVD mortality and was found in all age, sex, and race/ethnicity groups except Hispanics. Although substantial, this relative educational gradient in mortality among adults with diabetes was smaller than in the nondiabetic population. In absolute terms, diabetic adults with the lowest position on the educational scale suffered 503 excess deaths per 10,000 person-years of follow-up compared with those with the highest position. These absolute disparities were stronger than in the nondiabetic population. The results were even more striking for CVD mortality.

Conclusions: The risk of mortality differs substantially according to educational level among individuals with diabetes in the U.S. Although relative educational disparities in mortality are weaker in adults with versus without diabetes, their absolute impact is greater and translates into a major mortality burden.

Show MeSH
Related in: MedlinePlus