Impact of Childhood and Adult Socioeconomic Position (SEP) on Incidence of Type 2 Diabetes—The REGARDS Study, 2003–2016

Abstract

Exposure to socioeconomic stressors during early life may influence the incidence of type 2 diabetes (T2DM). We examined data from 1,207 African American (AA) and 4,149 white REGARDS participants aged ≥45 years with no evidence of T2DM at baseline (2003-2007), who completed the Childhood and Family Life Questionnaire (2011-2013) and the 2nd in-home visit (2013-2016). Incident T2DM cases were identified by self-reported physician diagnosis plus use of hypoglycemic drugs, fasting plasma glucose ≥126 mg/dL, or random plasma glucose ≥200 mg/dL. We estimated incidence rate as cases/1000 persons. Childhood SEP (CSEP) was derived from participants’ parental/caregiver education level and material assets. Adult SEP (ASEP) was derived from participants’ own education level and annual household income at baseline. SEP scores were categorized as low/medium/high. We fit multivariable logistic regression models to estimate adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) for the separate and simultaneous effects of SEP measures on T2DM incidence, stratified by race. In 9.1 years of follow-up, 572 new cases of T2DM occurred; crude incidence rate=106.8/1000 (AA=168.2/1000; white= 88.9/1000). Controlled for age, sex, and percent life lived in Stroke Belt, low CSEP was associated with incident T2DM in AAs (aOR=1.65, 95% CI 1.05-2.52) but not in whites (aOR=1.01, 95% CI 0.703-1.46). Low ASEP was associated with incident DM in both racial groups: AA aOR=2.57 (95% CI 1.42-4.64); white aOR=2.42 (95% CI 1.69-3.45). With both SEP measures in the model, CSEP was no longer significant in AA but ASEP remained significant in both racial groups. Controlling for traditional T2DM risk factors the ASEP ORs remained significant in AA and whites. Low CSEP was associated with incident T2DM among AA but not whites; however, this may reflect indirect action through low ASEP. Low ASEP was associated with T2DM in both racial groups, partly explained by traditional T2DM risk factors. Disclosure G.L.A. Beckles: None. C. Wu: None. L.A. McClure: None. A.P. Carson: Research Support; Self; Amgen Inc.. K.M. Bullard: None. G. Imperatore: None. F. Unverzagt: None. V.J. Howard: None.