Abstract
Aims/hypothesisChina has undergone rapid socioeconomic transition accompanied by lifestyle changes that are expected to have a profound impact on the health of its population. However, there is limited evidence from large nationwide studies about the relevance of socioeconomic status (SES) to risk of diabetes. We describe the associations of two key measures of SES with prevalent and incident diabetes in Chinese men and women.MethodsThe China Kadoorie Biobank study included 0.5 million adults aged 30–79 years recruited from ten diverse areas in China during 2004–2008. SES was assessed using the highest educational level attained and annual household income. Prevalent diabetes was identified from self-report and plasma glucose measurements. Incident diabetes was identified from linkage to disease and death registries and national health insurance claim databases. We estimated adjusted ORs and HRs for prevalent and incident diabetes associated with SES using logistic and Cox regression models, respectively.ResultsAt baseline, 30,066 (5.9%) participants had previously diagnosed (3.1%) or screen-detected (2.8%) diabetes among 510,219 participants included for cross-sectional analyses. There were 480,153 people without prevalent diabetes at baseline, of whom 9544 (2.0%) had new-onset diabetes during follow-up (median 7 years). Adjusted ORs (95% CIs) for prevalent diabetes, comparing highest vs lowest educational level, were 1.21 (1.09, 1.35) in men and 0.69 (0.63, 0.76) in women; for incident diabetes, the corresponding HRs were 1.27 (1.07, 1.51) and 0.80 (0.67, 0.95), respectively. For household income, the adjusted ORs for prevalent diabetes, comparing highest vs lowest categories, were 1.45 (1.34, 1.56) in men and 1.26 (1.19, 1.34) in women; for incident diabetes, the HRs were 1.36 (1.19, 1.55) and 1.06 (0.95, 1.17), respectively.Conclusions/interpretationAmong Chinese adults, the associations between education and diabetes prevalence and incidence differed qualitatively between men and women, whereas higher household income was positively associated with diabetes prevalence and incidence in both sexes, with a stronger relationship in men than in women.
Highlights
The prevalence of diabetes in China has increased markedly in the past few decades
Associations between socioeconomic status (SES) and prevalent diabetes Agestandardised diabetes prevalence increased with higher educational level and household income in men, but the patterns were less clear in women (Table 2)
After adjustment for age, study region, family history of diabetes and household income, there was a positive association between educational level and prevalent diabetes in men and an inverse association in women (Fig. 1)
Summary
The prevalence of diabetes in China has increased markedly in the past few decades. The proportion of Chinese adults estimated to have diabetes was 0.9% in 1980, 2.5% in 1994 and 10.9% in 2013 [1,2,3]. The increase is thought to be the most rapid worldwide, and it is related to China’s recent rapid economic development and urbanisation, which are contributing to socioeconomic and epidemiological transition [4]. In Hong Kong and Taiwan, where economic development and epidemiological transition are at a more advanced stage than in mainland China, an inverse association between SES and diabetes prevalence has been described [7]. In order to examine the recent socioeconomic pattern of diabetes risk in China, we describe the associations between SES and both prevalent and incident diabetes, using data from the China Kadoorie Biobank (CKB), a large prospective cohort study of about 0.5 million Chinese adults
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