Abstract
BackgroundBoth socioeconomic position (SEP) and type 2 diabetes have previously been found to be associated with mortality; however, little is known about the association between SEP, type 2 diabetes and long-term mortality when comorbidity is taken into account.MethodsWe conducted a population-based cohort study of all Danish citizens aged 40-69 years with no history of diabetes during 2001-2006 (N=2,330,206). The cohort was identified using nationwide registers, and it was followed for up to 11 years (mean follow-up was 9.5 years (SD: 2.6)). We estimated the age-standardised mortality rate (MR) and performed Poisson regression to estimate the mortality-rate-ratio (MRR) by educational level, income and cohabiting status among people with and without type 2 diabetes.ResultsWe followed 2,330,206 people for 22,971,026 person-years at risk and identified 139,681 individuals with type 2 diabetes. In total, 195,661 people died during the study period; 19,959 of these had type 2 diabetes. The age-standardised MR increased with decreasing SEP both for people with and without diabetes. Type 2 diabetes and SEP both had a strong impact on the overall mortality; the combined effect of type 2 diabetes and SEP on mortality was additive rather than multiplicative. Compared to women without diabetes and in the highest income quintile, the MRR’s were 2.8 (95%CI 2.6, 3.0) higher for women with type 2 diabetes in the lowest income quintile, while diabetes alone increased the risk of mortality 2.0 (95%CI 1.9, 2.2) times and being in the lowest income quintile without diabetes 1.8 (95%CI 1.7,1.9) times after adjusting for comorbidity. For men, the MRR’s were 2.7 (95%CI 2.5,2.9), 1.9 (95%CI 1.8,2.0) and 1.8 (95%CI 1.8,1.9), respectively.ConclusionBoth Type 2 diabetes and SEP were associated with the overall mortality. The relation between type 2 diabetes, SEP, and all-cause mortality was only partly explained by comorbidity.
Highlights
Type 2 diabetes is a major public health problem; its incidence is rising and the mortality from diabetes is high [1]
The funders had no role in study design, data collection andanalysis, decision to publish, or preparation of manuscript. Both socioeconomic position (SEP) and type 2 diabetes have previously been found to be associated with mortality; little is known about the association between SEP, type 2 diabetes and long-term mortality when comorbidity is taken into account
The age-standardised mortality rate (MR) increased with decreasing SEP both for people with and without diabetes
Summary
Type 2 diabetes is a major public health problem; its incidence is rising and the mortality from diabetes is high [1]. In Denmark, the relative income disparity is low, diabetes care is well-organized, and access to the health care system is free of charge. In this Danish context, we conducted a nationwide cohort study in which we aimed at examining the association between SEP, type 2 diabetes and the long-term mortality while taking comorbidity into account. Both socioeconomic position (SEP) and type 2 diabetes have previously been found to be associated with mortality; little is known about the association between SEP, type 2 diabetes and long-term mortality when comorbidity is taken into account
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