Independent roles of country of birth and socioeconomic status in the occurrence of type 2 diabetes

BMC Public Health

Annemarie Hennessy¹  Hilary Bambrick³  Louisa Jorm³  Seyed Morteza Shamshirgaran² 

[1] School of Medicine, University of Western Sydney, Sydney, Australia;Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran;Centre for Health Research, School of Medicine, University of Western Sydney, Sydney, Australia

关键词: Socioeconomic status;    Ethnicity;    Country of birth;    Type 2 diabetes;   

Others  :  1161401
DOI  :  10.1186/1471-2458-13-1223

 received in 2012-08-27, accepted in 2013-12-06,  发布年份 2013

【 摘 要 】

Background

There is strong evidence based on previous studies that ethnicity and socioeconomic status are important determinants of diversity in the occurrence of diabetes. However, the independent roles of socioeconomic status, country of birth and lifestyle factors in the occurrence of type 2 diabetes have not been clearly identified. This study investigated the relationships between socioeconomic status, country of birth and type 2 diabetes in a large diverse sample of residents of New South Wales, Australia, and aged 45 years and over.

Methods

The analysis used self-reported baseline questionnaire data from 266,848 participants in the 45 and Up Study. Educational attainment, work status and income were used as indicators of socioeconomic status. Logistic regression models were built to investigate associations between socioeconomic status, country of birth and type 2 diabetes.

Results

The adjusted odds of type 2 diabetes were significantly higher for people born in many overseas countries, compared to Australian-born participants. Compared with participants who had a university degree or higher qualification, the adjusted odds ratio (OR) for diabetes was higher in all other educational categories. Diabetes was more prevalent in people who were retired, unemployed or engaged in other types of work, compared with people who were in paid work. The prevalence of diabetes was higher in people with lower incomes. Compared with people who earned more than $50,000, the adjusted OR for diabetes was 2.05 (95% CI 1.95-2.14) for people who had an income less than $20,000 per annum. The relationships between socioeconomic factors and country of birth and diabetes were attenuated slightly when all were included in the model. Addition of smoking, obesity and physical activity to the model had marked impacts on adjusted ORs for some countries of birth, but relationships between diabetes and all measures of socioeconomic status and country of birth remained strong and significant.

Conclusions

Country of birth and socioeconomic status are independent predictors of type 2 diabetes. However, in this population, country of birth had a stronger association with type 2 diabetes.

【 授权许可】

   
2013 Shamshirgaran et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Shaw JE, Sicree RA, Zimmet PZ: Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract Jan 2010, 87(1):4-14.
• [2]Flood VM, Webb K, Lazarus R, Pang G: Use of self-report to monitor overweight and obesity inpopulations: some issues for consideration. Aust N Z J Public Health 2000, 24(1):96-99.
• [3]AIHW: Diabetes; Australian facts 2008. diabetes series no 8.cat.no CVD 40. Canberra: AIHW; 2008.
• [4]Dunstan DW, Zimmet PZ, Welborn TA, De Courten MP, Cameron AJ, Sicree RA, Dwyer T, Colagiuri S, Jolley D, Knuiman M, et al.: The rising prevalence of diabetes and impaired glucose tolerance: the Australian Diabetes. Obesity and lifestyle study. Diabetes Care 2002, 25(5):829-834.
• [5]Douglas P, Jutte LLR, Marni D: Brownell, administrative record linkage as a tool for public health research. Annu Rev Public Health 2011, 32:91-108.
• [6]Misra A, Ganda OP: Migration and its impact on adiposity and type 2 diabetes. Nutrition 2007, 23(9):696-708.
• [7]Evans JM, Newton RW, Ruta DA, MacDonald TM, Morris AD: Socio-economic status, obesity and prevalence of type 1 and type 2 diabetes mellitus. Diabet Med 2000, 17(6):478-480.
• [8]Connolly V, Unwin N, Sherriff P, Bilous R, Kelly W: Diabetes prevalence and socioeconomic status: a population based study showing increased prevalence of type 2 diabetes mellitus in deprived areas. J Epidemiol Community Health 2000, 54(3):173-177.
• [9]Maty SC, Everson-Rose SA, Haan MN, Raghunathan TE, Kaplan GA: Education, income, occupation, and the 34-year incidence (1965–99) of type 2 diabetes in the Alameda County Study. Int J Epidemiol 2005, 34(6):1274-1281.
• [10]Agardh E, Allebeck P, Hallqvist J, Moradi T, Sidorchuk A: Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. Int J Epidemiol 2011, 40(3):804-818.
• [11]Link CL, McKinlay JB: Disparities in the prevalence of diabetes: is it race/ethnicity or socioeconomic status? Results from the Boston Area Community Health (BACH) survey. Ethn Dis 2009, 19(3):288-292.
• [12]Hjelm K, Sundquist J, Apelquist J: The influence of socio-economic status and life style on self-reported health in diabetics and non-diabetics: a comparison of foreign born and Swedish-born individuals. Prim Health Care Res Dev 2002, 3:249-259.
• [13]Banks E, Redman S, Jorm L, Armstrong B, Bauman A, Beard J, Beral V, Byles J, Corbett S, Cumming R, et al.: Cohort profile: the 45 and up study. Int J Epidemiol 2008, 37(5):941-947.
• [14]ABS: Australian Bureau of Statistics 2008, Standard Australian Classification of Countries (SACC), Second Edition, cat. no. 1269.0. Canberra: ABS; 2008.
• [15]AIHW: Mortality over the twentieth century in Australia. Trend and patterns in major causes of death. Mortality and surveillance series. No.4 Cat No PHE 73. Canberra: AIHW; 2005.
• [16]Hodge AM, English DR, O’Dea K, Giles GG: Increased diabetes incidence in Greek and Italian migrants to Australia: how much can be explained by known risk factors? Diabetes Care 2004, 27(10):2330-2334.
• [17]Khan NA, Wang H, Anand S, Jin Y, Campbell NR, Pilote L, Quan H: Ethnicity and sex affect diabetes incidence and outcomes. Diabetes Care 2011, 34(1):96-101.
• [18]Abate N, Chandalia M: Ethnicity, type 2 diabetes & migrant Asian Indians. Indian J Med Res 2007, 125(3):251-258.
• [19]Uitewaal PJ, Manna DR, Bruijnzeels MA, Hoes AW, Thomas S: Prevalence of type 2 diabetes mellitus, other cardiovascular risk factors, and cardiovascular disease in Turkish and Moroccan immigrants in North West Europe: a systematic review. Prev Med 2004, 39(6):1068-1076.
• [20]Ujcic-Voortman JK, Schram MT, Der Bruggen MA J-v, Verhoeff AP, Baan CA: Diabetes prevalence and risk factors among ethnic minorities. Eur J Public Health 2009, 19(5):511-515.
• [21]Sheth T, Nair C, Nargundkar M, Anand S, Yusuf S: Cardiovascular and cancer mortality among Canadians of European, south Asian and Chinese origin from 1979 to 1993: an analysis of 1.2 million deaths. CMAJ 1999, 161(2):132-138.
• [22]Lee JW, Brancati FL, Yeh HC: Trends in the prevalence of type 2 diabetes in Asians versus whites: results from the United States National Health Interview Survey, 1997–2008. Diabetes Care 2011, 34(2):353-357. Epub 2011 Jan 2017
• [23]Abate N, Chandalia M: The impact of ethnicity on type 2 diabetes. J Diabetes Complications 2003, 17(1):39-58.
• [24]Agardh EE, Ahlbom A, Andersson T, Efendic S, Grill V, Hallqvist J, Ostenson CG: Socio-economic position at three points in life in association with type 2 diabetes and impaired glucose tolerance in middle-aged Swedish men and women. Int J Epidemiol 2007, 36(1):84-92.
• [25]Agardh EE, Ahlbom A, Andersson T, Efendic S, Grill V, Hallqvist J, Ostenson CG: Explanations of socioeconomic differences in excess risk of type 2 diabetes in Swedish men and women. Diabetes Care 2004, 27(3):716-721.
• [26]Margolis KL, Lihong Q, Brzyski R, Bonds DE, Howard BV, Kempainen S, Simin L, Robinson JG, Safford MM, Tinker LT, et al.: Validity of diabetes self-reports in the Women’s Health Initiative: comparison with medication inventories and fasting glucose measurements. Clin Trials 2008, 5(3):240-247.