Lifestyle Changes And Education Can Counter Diabetes Risk Associated With Lower SES

It may seem intuitive that people with lower socioeconomic status are more likely to have diabetes, and two recent studies have correlated death from diabetes with poverty.

A study conducted by Baqiyyah N. Conway, PhD, and his colleagues from Vanderbilt University, found that poor people with diabetes have a higher risk of death than poor people without diabetes. The people with the greatest risk of death from diabetes are poor African Americans.

Dr. Conway’s study included 12,498 people with diabetes and 49,914 participants without diabetes. The participants ranged from 40 to 79 years of age.

After observing the participants for six years, the study found the following:


  • 13.5 percent of people with diabetes and 7.3 percent of those without diabetes died.
  • African Americans with diabetes had a hazard ratio of 1.84 for death compared with African Americans without diabetes.
  • Caucasians with diabetes had a hazard ratio of 1.80 for death compared with Caucasians without diabetes.
  • The risk of death was lower among African Americans with diabetes than whites with diabetes, with a hazard ratio of 0.78.
    • A hazard ratio explains how much an event happens in one group versus another over a set period of time. In this case, the set period is six years. A hazard ratio of more than one means that the event happens more in one group than the other.

These findings indicate that poverty or lower socioeconomic status is a predictor of death among both African American and Caucasians with diabetes. The more impoverished the individual, the more likely they will die from diabetes.

Other diabetes risk factors that increased death rates among diabetic patients include a history of heart disease, high blood pressure, incidences of stroke. Patients who were taking insulin also had a greater risk of dying.

Dr. Conway’s research can be read in Diabetes Care, a journal of the American Diabetes Association. The article was published on August 21, 2012.

Additionally, a European study has been released that describe its findings as the “most in-depth look yet at the link between socioeconomic status and diabetes risk.”

The Whitehall II cohort study was also published on August 21, 2012. The findings were published in British Medical Journal (BMJ) and measure the effect of socioeconomic status in relation to Type 2 diabetes.

The first Whitehall study was conducted in the late 1960s, and was the first research that brought to light the disparity between health outcomes and socioeconomic status.

“Thus, identification of those groups at increased risk of Type 2 diabetes, together with an understanding of the mechanisms involved, remains a public health priority,” write the researchers from Switzerland, England, France, Hungary and Scotland.

Whereas the Conway study included people both with and without diabetes, the Whitehall study looked at participants who were diabetes free at the study’s onset. Participants were 7,237  London civil workers, averaging around the age of 49. The study followed the participants for 14 years and found that 818 of the 7,237 were diagnosed with diabetes

These were their findings:

  • Civil servants in the lowest occupational category had a 1.86-fold greater risk of developing diabetes compared to colleagues in the highest occupational category.
    • Socioeconomic status was determined by looking at the types of jobs the workers were doing, their education, salary, social status and level of responsibility at work.
    • Health behaviors and BMI were found to be responsible for up to 45% of the socioeconomic differential in both men and women.
      • This means that health behaviors such as smoking, alcohol consumption, diet, and physical activity along with Body Mass Index determined if someone had a low SES or high SES by almost 50%.
      • When taking biological risk factors into account, this differential rose by 53%.

These findings point to the possibility of decreasing diabetes risk by changing certain diabetes risk factors such as health behaviors and BMI.

“Type 2 diabetes can be delayed or prevented among people at high risk who make intensive lifestyle modifications. Further efforts should be made to promote and enable the adoption of healthy lifestyles among the disadvantaged fractions of society.”

Conway’s study has determined that lower socioeconomic status results in more deaths from diabetes, and the Whitehall II study finds that lower SES can be less of a negative factor if lifestyle changes are implemented.

Yet in James P. Smith’s “Diabetes and the Rise of the SES Health Gradient,” (NBER Working Paper 12905), these lifestyle changes are easier said than done. People with lower SES face three main obstacles.

“Those in lower education groups face a triple threat with diabetes. First, at least in more recent years, they are of slightly higher risk in contracting the disease. Second, they remain at considerably greater risk of having their diabetes undiagnosed and presumably untreated. Third, even after diagnosis, they have considerably more difficulty in successful self-management of the disease using the complex but effective treatments necessary to diminish the negative health consequences associated with diabetes.”

Smith determined that ethnicity becomes less important over time. Education becomes the determining factor in diabetes detection and prevention. The patient must participant in careful and involved self-management. These include monitoring their blood glucose levels, balancing insulin injection doses with food intake and physical activity, and consulting regularly with health care providers.

To combat diabetes, lower SES can be countered by decreasing BMI, making healthier lifestyle changes, and becoming informed about diabetes treatment and management.


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