Socioeconomic inequalities impact multiple aspects of diabetes care
medwireNews: Data from Scotland show that low socioeconomic status increases people’s risk for developing type 2 diabetes, while for those with type 1 diabetes it increases time spent with complications and reduces life expectancy.
The analyses from the Scottish Diabetes Research Network epidemiology group were presented at the virtual 57th EASD Annual Meeting by Jack Wang and Andreas Höhn, both from the University of Edinburgh in the UK.
Höhn reported that, at the age of 50 years, the average remaining life expectancy was 25.1 years in women with type 1 diabetes and 22.2 years in men.
But this varied markedly with socioeconomic status; men in the least versus the most deprived quintiles had average remaining life expectancies of 26.3 versus 18.7 years, and for women it was a corresponding 29.3 and 21.2 years.
Furthermore, the most deprived people spent more of their remaining years living with diabetes complications. For example, men in the least versus the most deprived quintiles lived for an average of 9.3 versus 4.9 years before developing at least one complication.
At the start of follow-up, just 38% of the cohort was free of diabetes complications, and estimates of time lived without complications was adjusted to allow for the fact that the majority of the cohort already had at least one. The most frequent complications were nephropathy and cardiovascular disease.
These findings were based on data from 8591 people with type 1 diabetes (55% men), aged an average of 61 years with an average diabetes duration of 28 years, who were identified in a national database and followed up between 2013 and 2018.
The associations between deprivation and life expectancy and time free of complications barely changed after accounting for smoking status, BMI, glycated hemoglobin, blood pressure, and lipid profiles, Höhn noted.
“Our results show clearly that deprived individuals experience complications much earlier and accumulate them more rapidly,” he said.
“Therefore, keeping deprived individuals free from complications for as long as possible is likely to have the biggest impact on reducing the socioeconomic gap in both health-adjusted life expectancy and life expectancy.”
In the second presentation, Wang reported data from 255,764 people with type 2 diabetes in Scotland in 2021. The prevalence in men ranged from 7.4% for those in the least deprived quintile to 12.6% for those in the most deprived quintile, and in women the corresponding rates were 4.3% and 9.5%.
This represented a significantly increased risk for type 2 diabetes for people in the most versus the least deprived quintiles, and, moreover, the impact of deprivation had increased since the team’s previous study in 2007. For example, men in the most versus the least deprived quintiles had a 1.58-fold increased type 2 diabetes risk in 2007 and a 1.89-fold increased risk in 2021.
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