Combined effects of diabetes and low household income on mortality: a 12-year follow-up study of 505 677 Korean adults

W. Y. Shin, HyeonChang Kim, T. Lee, D. H. Jeon, K. H. Ha, D. J. Kim, Hyuk-Jae Chang

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Abstract

Aim: To examine the effects of diabetes, low income and their combination on mortality in the Korean population. Methods: We analysed a total of 505 677 people (53.9% male) aged 40–79 years old from the National Health Insurance Service-National Health Screening (NHIS-HEALS) cohort. Ten levels of household income were used as indicators of economic status. Diabetes was defined as elevated fasting blood glucose (≥ 6.9 mmol/l) and/or use of glucose-lowering drugs or insulin. Covariates of age, sex, BMI, smoking and Charlson Comorbidity Index were determined at baseline. Outcomes were total and cause-specific mortality over 12 years. Cox's proportional hazard regression models were used to estimate hazard ratios (HRs) for mortality according to the presence of diabetes, household income and their combination. Results: Lower household income was associated with higher mortality from all causes, cardiovascular disease, cancer and non-cancer non-cardiovascular causes. Excessive mortality due to low incomes was observed in both people with and without diabetes. In men, the adjusted HR [95% confidence interval (CI)] of mortality was 1.38 (1.34 to 1.42) for low-income only, 1.48 (1.42 to 1.55) for diabetes only and 1.95 (1.86 to 2.05) for diabetes and low-income combined, relative to the normal glucose and high income group. Corresponding HR (95% CI) in women were 1.19 (1.14 to 1.24), 1.54 (1.44 to 1.64) and 1.87 (1.75 to 2.01), respectively. Conclusion: Both low household income and the presence of diabetes independently increase the risk of mortality, but their combined effects on mortality may be different between men and women.

Original languageEnglish
Pages (from-to)1345-1354
Number of pages10
JournalDiabetic Medicine
Volume35
Issue number10
DOIs
Publication statusPublished - 2018 Oct 1

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Mortality
National Health Programs
Confidence Intervals
Glucose
Proportional Hazards Models
Blood Glucose
Comorbidity
Fasting
Cardiovascular Diseases
Smoking
Economics
Insulin
Health
Pharmaceutical Preparations
Population
Neoplasms

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

@article{f3685c144adb4f2fba90f41fd83391fe,
title = "Combined effects of diabetes and low household income on mortality: a 12-year follow-up study of 505 677 Korean adults",
abstract = "Aim: To examine the effects of diabetes, low income and their combination on mortality in the Korean population. Methods: We analysed a total of 505 677 people (53.9{\%} male) aged 40–79 years old from the National Health Insurance Service-National Health Screening (NHIS-HEALS) cohort. Ten levels of household income were used as indicators of economic status. Diabetes was defined as elevated fasting blood glucose (≥ 6.9 mmol/l) and/or use of glucose-lowering drugs or insulin. Covariates of age, sex, BMI, smoking and Charlson Comorbidity Index were determined at baseline. Outcomes were total and cause-specific mortality over 12 years. Cox's proportional hazard regression models were used to estimate hazard ratios (HRs) for mortality according to the presence of diabetes, household income and their combination. Results: Lower household income was associated with higher mortality from all causes, cardiovascular disease, cancer and non-cancer non-cardiovascular causes. Excessive mortality due to low incomes was observed in both people with and without diabetes. In men, the adjusted HR [95{\%} confidence interval (CI)] of mortality was 1.38 (1.34 to 1.42) for low-income only, 1.48 (1.42 to 1.55) for diabetes only and 1.95 (1.86 to 2.05) for diabetes and low-income combined, relative to the normal glucose and high income group. Corresponding HR (95{\%} CI) in women were 1.19 (1.14 to 1.24), 1.54 (1.44 to 1.64) and 1.87 (1.75 to 2.01), respectively. Conclusion: Both low household income and the presence of diabetes independently increase the risk of mortality, but their combined effects on mortality may be different between men and women.",
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Combined effects of diabetes and low household income on mortality : a 12-year follow-up study of 505 677 Korean adults. / Shin, W. Y.; Kim, HyeonChang; Lee, T.; Jeon, D. H.; Ha, K. H.; Kim, D. J.; Chang, Hyuk-Jae.

In: Diabetic Medicine, Vol. 35, No. 10, 01.10.2018, p. 1345-1354.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Combined effects of diabetes and low household income on mortality

T2 - a 12-year follow-up study of 505 677 Korean adults

AU - Shin, W. Y.

AU - Kim, HyeonChang

AU - Lee, T.

AU - Jeon, D. H.

AU - Ha, K. H.

AU - Kim, D. J.

AU - Chang, Hyuk-Jae

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Aim: To examine the effects of diabetes, low income and their combination on mortality in the Korean population. Methods: We analysed a total of 505 677 people (53.9% male) aged 40–79 years old from the National Health Insurance Service-National Health Screening (NHIS-HEALS) cohort. Ten levels of household income were used as indicators of economic status. Diabetes was defined as elevated fasting blood glucose (≥ 6.9 mmol/l) and/or use of glucose-lowering drugs or insulin. Covariates of age, sex, BMI, smoking and Charlson Comorbidity Index were determined at baseline. Outcomes were total and cause-specific mortality over 12 years. Cox's proportional hazard regression models were used to estimate hazard ratios (HRs) for mortality according to the presence of diabetes, household income and their combination. Results: Lower household income was associated with higher mortality from all causes, cardiovascular disease, cancer and non-cancer non-cardiovascular causes. Excessive mortality due to low incomes was observed in both people with and without diabetes. In men, the adjusted HR [95% confidence interval (CI)] of mortality was 1.38 (1.34 to 1.42) for low-income only, 1.48 (1.42 to 1.55) for diabetes only and 1.95 (1.86 to 2.05) for diabetes and low-income combined, relative to the normal glucose and high income group. Corresponding HR (95% CI) in women were 1.19 (1.14 to 1.24), 1.54 (1.44 to 1.64) and 1.87 (1.75 to 2.01), respectively. Conclusion: Both low household income and the presence of diabetes independently increase the risk of mortality, but their combined effects on mortality may be different between men and women.

AB - Aim: To examine the effects of diabetes, low income and their combination on mortality in the Korean population. Methods: We analysed a total of 505 677 people (53.9% male) aged 40–79 years old from the National Health Insurance Service-National Health Screening (NHIS-HEALS) cohort. Ten levels of household income were used as indicators of economic status. Diabetes was defined as elevated fasting blood glucose (≥ 6.9 mmol/l) and/or use of glucose-lowering drugs or insulin. Covariates of age, sex, BMI, smoking and Charlson Comorbidity Index were determined at baseline. Outcomes were total and cause-specific mortality over 12 years. Cox's proportional hazard regression models were used to estimate hazard ratios (HRs) for mortality according to the presence of diabetes, household income and their combination. Results: Lower household income was associated with higher mortality from all causes, cardiovascular disease, cancer and non-cancer non-cardiovascular causes. Excessive mortality due to low incomes was observed in both people with and without diabetes. In men, the adjusted HR [95% confidence interval (CI)] of mortality was 1.38 (1.34 to 1.42) for low-income only, 1.48 (1.42 to 1.55) for diabetes only and 1.95 (1.86 to 2.05) for diabetes and low-income combined, relative to the normal glucose and high income group. Corresponding HR (95% CI) in women were 1.19 (1.14 to 1.24), 1.54 (1.44 to 1.64) and 1.87 (1.75 to 2.01), respectively. Conclusion: Both low household income and the presence of diabetes independently increase the risk of mortality, but their combined effects on mortality may be different between men and women.

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