Impact of Socioeconomic Status
on Cardiovascular Disease and
Mortality in 24,947 Individuals
With Type 1 Diabetes
Araz Rawshani,1,2 Ann-Marie Svensson,2,3
Annika Rosengren,1,2 Bjorn Eliasson,1,2
and Soffia Gudbjornsdottir 2,3
NDR, Sweden
DOI: 10.2337/dc15-0145
Socioeconomic status (SES) is a powerful predictor of cardiovascular disease (CVD)
and death. We examined the association in a large cohort of patients with type 1
Clinical data from the Swedish National Diabetes Register were linked to national
registers, whereby information on income, education, marital status, country of
birth, comorbidities, and events was obtained. Patients were followed until a first
incident event, death, or end of follow-up. The association between socioeconomic
variables and the outcomes was modeled using Cox regression, with rigorous
covariate adjustment.
We included 24,947 patients. Mean (SD) age and follow-up was 39.1 (13.9) and 6.0
(1.0) years. Death and fatal/nonfatal CVD occurred in 926 and 1378 individuals.
Compared with being single, being married was associated with 50% lower risk of
death, cardiovascular (CV) death, and diabetes-related death. Individuals in the
two lowest quintiles had twice as great a risk of fatal/nonfatal CVD, coronary heart
disease, and stroke and roughly three times as great a risk of death, diabetesrelated
death, and CV death as individuals in the highest income quintile. Compared
with having £9 years of education, individuals with a college/university
degree had 33% lower risk of fatal/nonfatal stroke. Immigrants had 19%, 33%,
and 45% lower risk of fatal/nonfatal CVD, all-cause death, and diabetes-related
death, respectively, compared with Swedes. Men had 44%, 63%, and 29% greater
risk of all-cause death, CV death, and diabetes-related death.
Low SES increases the risk of CVD and death by a factor of 2–3 in type 1 diabetes.
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