Relative and combined effects of socioeconomic status and diabetes on mortality: A nationwide cohort study

Nam Hoon Kim, Tae Joon Kim, Nan Hee Kim, Kyung Mook Choi, Sei-Hyun Baik, Dong Seop Choi, Yousung Park, Sin Gon Kim

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Both low socioeconomic status (SES) and diabetes mellitus (DM) are important risk factors for mortality. However, little is known about their combined effects and relative contribution to the mortality risk. From a nationwide cohort provided by the National Health Insurance Service in Korea, 153,075 subjects who were over 30 years of age from 2003 to 2004 were followed-up until 2010. The SESs of the subjects in the DM and non-DM (NDM) groups were categorized into 3 groups (highest 30% as S1, middle 40% as S2, and lowest 30% as S3) based on the subjects' income levels. During the 7.9-year follow-up, 3933 deaths occurred. When the subjects were stratified into 6 groups by their socioeconomic and diabetes status, a linearly increasing pattern of the hazard ratio (HR) of mortality from the higher SES without diabetes group (NDM-S1, as a reference) to the lower SES with diabetes group (DM-S3; HR, 2.04, 95% confidence interval (CI), 1.80-2.36) was observed (P for trend < 0.001). Notably, subjects with DM in the highest SES group (DM-S1) had a significantly higher mortality risk than did non-DM subjects in the lowest SES group (NDM-S3). This pattern was maintained in cause-specific mortality but was more prominent in cardiovascular disease (CVD) and less prominent in cancer mortality. The association was not affected by gender; however, in individuals <60 years of age, the combined effects of SES and DM on mortality were more prominent (DM-S3; HR, 3.68, 95% CI, 2.95-4.60) than in those ≥60 years of age. Low SES and DM were major determinants of mortality and synergistically increased the risks of all-cause, CVD, and cancer mortality.

Original languageEnglish
Article number5
JournalMedicine (United States)
Volume95
Issue number30
DOIs
Publication statusPublished - 2016 Jul 1

Fingerprint

Social Class
Cohort Studies
Diabetes Mellitus
Mortality
National Health Programs
Cardiovascular Diseases
Confidence Intervals
Korea
Neoplasms

Keywords

  • cardiovascular mortality
  • diabetes mellitus
  • health disparity
  • mortality
  • socioeconomic status

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Relative and combined effects of socioeconomic status and diabetes on mortality : A nationwide cohort study. / Kim, Nam Hoon; Kim, Tae Joon; Kim, Nan Hee; Choi, Kyung Mook; Baik, Sei-Hyun; Choi, Dong Seop; Park, Yousung; Kim, Sin Gon.

In: Medicine (United States), Vol. 95, No. 30, 5, 01.07.2016.

Research output: Contribution to journalArticle

@article{66086590b874436883669a29eb985de3,
title = "Relative and combined effects of socioeconomic status and diabetes on mortality: A nationwide cohort study",
abstract = "Both low socioeconomic status (SES) and diabetes mellitus (DM) are important risk factors for mortality. However, little is known about their combined effects and relative contribution to the mortality risk. From a nationwide cohort provided by the National Health Insurance Service in Korea, 153,075 subjects who were over 30 years of age from 2003 to 2004 were followed-up until 2010. The SESs of the subjects in the DM and non-DM (NDM) groups were categorized into 3 groups (highest 30{\%} as S1, middle 40{\%} as S2, and lowest 30{\%} as S3) based on the subjects' income levels. During the 7.9-year follow-up, 3933 deaths occurred. When the subjects were stratified into 6 groups by their socioeconomic and diabetes status, a linearly increasing pattern of the hazard ratio (HR) of mortality from the higher SES without diabetes group (NDM-S1, as a reference) to the lower SES with diabetes group (DM-S3; HR, 2.04, 95{\%} confidence interval (CI), 1.80-2.36) was observed (P for trend < 0.001). Notably, subjects with DM in the highest SES group (DM-S1) had a significantly higher mortality risk than did non-DM subjects in the lowest SES group (NDM-S3). This pattern was maintained in cause-specific mortality but was more prominent in cardiovascular disease (CVD) and less prominent in cancer mortality. The association was not affected by gender; however, in individuals <60 years of age, the combined effects of SES and DM on mortality were more prominent (DM-S3; HR, 3.68, 95{\%} CI, 2.95-4.60) than in those ≥60 years of age. Low SES and DM were major determinants of mortality and synergistically increased the risks of all-cause, CVD, and cancer mortality.",
keywords = "cardiovascular mortality, diabetes mellitus, health disparity, mortality, socioeconomic status",
author = "Kim, {Nam Hoon} and Kim, {Tae Joon} and Kim, {Nan Hee} and Choi, {Kyung Mook} and Sei-Hyun Baik and Choi, {Dong Seop} and Yousung Park and Kim, {Sin Gon}",
year = "2016",
month = "7",
day = "1",
doi = "10.1097/MD.0000000000004403",
language = "English",
volume = "95",
journal = "Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries",
issn = "0025-7974",
publisher = "Lippincott Williams and Wilkins",
number = "30",

}

TY - JOUR

T1 - Relative and combined effects of socioeconomic status and diabetes on mortality

T2 - A nationwide cohort study

AU - Kim, Nam Hoon

AU - Kim, Tae Joon

AU - Kim, Nan Hee

AU - Choi, Kyung Mook

AU - Baik, Sei-Hyun

AU - Choi, Dong Seop

AU - Park, Yousung

AU - Kim, Sin Gon

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Both low socioeconomic status (SES) and diabetes mellitus (DM) are important risk factors for mortality. However, little is known about their combined effects and relative contribution to the mortality risk. From a nationwide cohort provided by the National Health Insurance Service in Korea, 153,075 subjects who were over 30 years of age from 2003 to 2004 were followed-up until 2010. The SESs of the subjects in the DM and non-DM (NDM) groups were categorized into 3 groups (highest 30% as S1, middle 40% as S2, and lowest 30% as S3) based on the subjects' income levels. During the 7.9-year follow-up, 3933 deaths occurred. When the subjects were stratified into 6 groups by their socioeconomic and diabetes status, a linearly increasing pattern of the hazard ratio (HR) of mortality from the higher SES without diabetes group (NDM-S1, as a reference) to the lower SES with diabetes group (DM-S3; HR, 2.04, 95% confidence interval (CI), 1.80-2.36) was observed (P for trend < 0.001). Notably, subjects with DM in the highest SES group (DM-S1) had a significantly higher mortality risk than did non-DM subjects in the lowest SES group (NDM-S3). This pattern was maintained in cause-specific mortality but was more prominent in cardiovascular disease (CVD) and less prominent in cancer mortality. The association was not affected by gender; however, in individuals <60 years of age, the combined effects of SES and DM on mortality were more prominent (DM-S3; HR, 3.68, 95% CI, 2.95-4.60) than in those ≥60 years of age. Low SES and DM were major determinants of mortality and synergistically increased the risks of all-cause, CVD, and cancer mortality.

AB - Both low socioeconomic status (SES) and diabetes mellitus (DM) are important risk factors for mortality. However, little is known about their combined effects and relative contribution to the mortality risk. From a nationwide cohort provided by the National Health Insurance Service in Korea, 153,075 subjects who were over 30 years of age from 2003 to 2004 were followed-up until 2010. The SESs of the subjects in the DM and non-DM (NDM) groups were categorized into 3 groups (highest 30% as S1, middle 40% as S2, and lowest 30% as S3) based on the subjects' income levels. During the 7.9-year follow-up, 3933 deaths occurred. When the subjects were stratified into 6 groups by their socioeconomic and diabetes status, a linearly increasing pattern of the hazard ratio (HR) of mortality from the higher SES without diabetes group (NDM-S1, as a reference) to the lower SES with diabetes group (DM-S3; HR, 2.04, 95% confidence interval (CI), 1.80-2.36) was observed (P for trend < 0.001). Notably, subjects with DM in the highest SES group (DM-S1) had a significantly higher mortality risk than did non-DM subjects in the lowest SES group (NDM-S3). This pattern was maintained in cause-specific mortality but was more prominent in cardiovascular disease (CVD) and less prominent in cancer mortality. The association was not affected by gender; however, in individuals <60 years of age, the combined effects of SES and DM on mortality were more prominent (DM-S3; HR, 3.68, 95% CI, 2.95-4.60) than in those ≥60 years of age. Low SES and DM were major determinants of mortality and synergistically increased the risks of all-cause, CVD, and cancer mortality.

KW - cardiovascular mortality

KW - diabetes mellitus

KW - health disparity

KW - mortality

KW - socioeconomic status

UR - http://www.scopus.com/inward/record.url?scp=84982861746&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84982861746&partnerID=8YFLogxK

U2 - 10.1097/MD.0000000000004403

DO - 10.1097/MD.0000000000004403

M3 - Article

C2 - 27472736

AN - SCOPUS:84982861746

VL - 95

JO - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

JF - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

SN - 0025-7974

IS - 30

M1 - 5

ER -