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Göteborgs universitets publikationer

Association Between Socioeconomic Status and Mortality, Cardiovascular Disease, and Cancer in Patients With Type 2 Diabetes

Författare och institution:
A. Rawshani (-); Ann-Marie Svensson (Institutionen för medicin, avdelningen för molekylär och klinisk medicin); B. Zethelius (-); Björn Eliasson (Institutionen för medicin, avdelningen för molekylär och klinisk medicin); Annika Rosengren (-); Soffia Gudbjörnsdottir (Institutionen för medicin, avdelningen för molekylär och klinisk medicin)
Publicerad i:
JAMA internal medicine, 176 ( 8 ) s. 1146-54
2168-6114 (Electronic) 2168-6106 (Linking)
Artikel, refereegranskad vetenskaplig
Sammanfattning (abstract):
IMPORTANCE: The association between socioeconomic status and survival based on all-cause, cardiovascular (CV), diabetes-related, and cancer mortality in type 2 diabetes has not been examined in a setting of persons with equitable access to health care with adjustment for important confounders. OBJECTIVE: To determine whether income, educational level, marital status, and country of birth are independently associated with all-cause, CV, diabetes-related, and cancer mortality in persons with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS: A study including all 217364 individuals younger than 70 years with type 2 diabetes in the Sweden National Diabetes Register (January 1, 2003, to December 31, 2010) who were monitored through December 31, 2012, was conducted. A Cox proportional hazards regression model with up to 17 covariates was used for analysis. MAIN OUTCOMES AND MEASURES: All-cause, CV, diabetes-related, and cancer mortality. RESULTS: Of the 217364 persons included in the study, mean (SD) age was 58.3 (9.3) years and 130839 of the population (60.2%) was male. There were a total of 19105 all-cause deaths with 11423 (59.8%), 6984 (36.6%), and 6438 (33.7%) CV, diabetes-related, or cancer deaths, respectively. Compared with being single, hazard ratios (HRs) for married individuals, determined using fully adjusted models, for all-cause, CV, and diabetes-related mortality were 0.73 (95% CI, 0.70-0.77), 0.67 (95% CI, 0.63-0.71), and 0.62 (95% CI, 0.57-0.67), respectively. Marital status was not associated with overall cancer mortality, but married men had a 33% lower risk of prostate cancer mortality compared with single men, with an HR of 0.67 (95% CI, 0.50-0.90). Comparison of HRs for the lowest vs highest income quintiles for all-cause, CV, diabetes-related, and cancer mortality were 1.71 (95% CI, 1.60-1.83), 1.87 (95% CI, 1.72-2.05), 1.80 (95% CI, 1.61-2.01), and 1.28 (95% CI, 1.14-1.44), respectively. Compared with native Swedes, HRs for all-cause, CV, diabetes-related, and cancer mortality for non-Western immigrants were 0.55 (95% CI, 0.48-0.63), 0.46 (95% CI, 0.38-0.56), 0.38 (95% CI, 0.29-0.49), and 0.72 (95% CI, 0.58-0.88), respectively, and these HRs were virtually unaffected by covariate adjustment. Hazard ratios for those with a college/university degree compared with 9 years or less of education were 0.85 (95% CI, 0.80-0.90), 0.84 (95% CI, 0.78-0.91), and 0.84 (95% CI, 0.76-0.93) for all-cause, CV, and cancer mortality, respectively. CONCLUSIONS AND RELEVANCE: Independent of risk factors, access to health care, and use of health care, socioeconomic status is a powerful predictor of all-cause and CV mortality but was not as strong as a predictor of death from cancer.
Ämne (baseras på Högskoleverkets indelning av forskningsämnen):
Klinisk medicin
Postens nummer:
Posten skapad:
2016-08-05 10:40
Posten ändrad:
2016-08-18 11:46

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