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

W. Y. Shin, H. C. Kim, T. Lee, D. H. Jeon, K. H. Ha, D. J. Kim, H. J. 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

Bibliographical note

Funding Information:
This work was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI13C0715). This study used NHIS-HealS data (NHIS-2017-2-319) made by National Health Insurance Service (NHIS).

Funding Information:
This work was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI13C0715). This study used NHIS-HEALS data (NHIS- 2017-2-319) made by National Health Insurance Service (NHIS).

Funding Information:
This work was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI13C0715). This study used NHIS-HEALS data (NHIS-2017-2-319) made by National Health Insurance Service (NHIS). WYS contributed the study concept, analysed and interpreted data, and drafted the manuscript. HCK conceived of and designed the study, planned statistical analysis, interpreted analysed data, wrote the final version of the manuscript, and supervised the study. THL analysed data, reviewed and revised the manuscript, and provided administrative support. DHJ conceived of and designed the study, and revised the manuscript, and provided administrative support. KHH planned statistical analysis, interpreted analysed data, reviewed and revised the manuscript. DJK and HJC interpreted analysed data, reviewed and revised the manuscript. HCK is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Publisher Copyright:
© 2018 Diabetes UK

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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