Abstract P229: The Association Of Cumulative Socioeconomic Status And Incident Type 2 Diabetes Among African Americans: The Jackson Heart Study

Abstract

Background: The burden of type 2 diabetes (T2D) is disproportionately higher among racial and ethnic minorities, particularly African American individuals who have low socioeconomic status (SES). According to the cumulative SES life-course model, stressful experiences in early life and later life can accumulate to influence disease risk. Yet, little is known about the association between cumulative SES, or the combined effects of different SES phenotypes (i.e., education, wealth, income, etc.), over the life course and development of T2D. Objective: To estimate the association of cumulative SES and incident T2D among men and women without T2D and cardiovascular disease at baseline (2000-2004) from the Jackson Heart Study (JHS) (n=3078). Methods: Using cohort data from JHS (mean age 52.8 years; 1969 women, 1109 men), we derived standardized cumulative SES scores at baseline, conceptualized using 6 SES indicators (e.g. educational attainment, wealth, income, occupation, employment status and mother’s education) and dichotomized the score as high SES (median and above - referent) and low SES (below the median). Incident T2D was defined at exam 2 (2005-2008) or exam 3 (2009-2013) based on a fasting glucose ≥126 mg/dL, or HbA1c ≥ 6.5, or those who had been on diabetic medication 2 weeks prior to these visits, or those who reported a physician diagnosis. Interval censoring proportional hazards regression was used to estimate the association between cumulative SES and incident T2D using hazard ratios (HR, 95% confidence interval-CI), where time-to-event was approximated as the interval between the first visit and the visit in which T2D was ascertained. Sex differences were evaluated using interaction terms and descriptive statistics. The fully-adjusted model included baseline covariates: age, waist circumference, health behaviors, and family history of diabetes. Results: There were 544 total incident T2D cases and 65% (351) of cases were characterized as having low SES. The dichotomized cumulative score was associated with incident T2D ( p <0.05) in unadjusted chi square analyses. In the fully-adjusted models, low (vs. high) cumulative SES and the standardized score were marginally associated with incident T2D (HR 1.14; 95% CI (0.95, 1.38) and HR 0.99; 95% CI (0.90, 1.08), respectively). There were no significant sex differences in the association between cumulative SES and incident T2D. Conclusion: Low cumulative SES was not significantly associated with development of T2D when adjusting for potential confounders. Future work should consider examination of adverse experiences related to low SES and other environmental factors such as built environment and neighborhood SES.