Associations between race, lifecourse socioeconomic position and prevalence of diabetes among US women and men: results from a population-based panel study
- 1Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, New York, USA
- 2Center for Rural Community Health, Bassett Research Institute, Cooperstown, New York, USA
- 3Division of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
- 4Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Rensselaer, New York, USA
- Correspondence to Dr Tabassum Insaf, Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York at Albany, 1 University Place, Room 131, Rensselaer, NY 12144, USA;
- Received 28 February 2013
- Revised 5 November 2013
- Accepted 6 November 2013
- Published Online First 6 December 2013
Background Few studies have examined the degree to which racial disparities in the development of diabetes are accounted by differences in lifecourse socioeconomic position (SEP). We assessed the association between race, lifecourse SEP measures and prevalence of diabetes in a representative US sample of black and white adults.
Methods A generalised estimating equations approach was used with a sample of 3497 adults from the Americans’ Changing Lives study. Sex-specific models were calculated to compute prevalence ratios (PR) for associations of race and SEP with self-reported diagnoses of diabetes.
Results For men, childhood and adult SEP were unrelated to diabetes, and adjustment for lifecourse SEP had little effect on the excess diabetes in blacks (PR=1.56, 95% CI 1.11 to 2.21). Adjustment for measures of lifecourse SEP reduced the PR for the association between race and diabetes in women from 1.96 (95% CI 1.52 to 2.54) to 1.40 (95% CI 1.04 to 1.87) with the respondent's education responsible for most of the reduction in the association. However, diabetes was also inversely associated with father's education, and low SEP throughout the lifecourse was associated with a nearly threefold increase in diabetes (PR=2.89, 95% CI 2.10 to 3.99).
Conclusions Racial disparities in diabetes existed among both men and women, but lifecourse SEP was related to diabetes only among women. The pathway and cumulative hypotheses for lifecourse SEP effects on diabetes may be especially salient for women.