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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
Author(s) -
Shin W. Y.,
Kim H. C.,
Lee T.,
Jeon D.H.,
Ha K. H.,
Kim D. J.,
Chang H.J.
Publication year - 2018
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13695
Subject(s) - medicine , hazard ratio , diabetes mellitus , national death index , proportional hazards model , confidence interval , demography , population , cohort , cohort study , body mass index , gerontology , environmental health , endocrinology , sociology
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 ( HR s) 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.