BACKGROUND: Diabetes and its cardiovascular complications are more common in adults of low socioeconomic position (SEP). In the US, the past decade has seen the establishment of many programs to reduce cardiovascular risk in persons with diabetes, but their effect on socioeconomic disparities is uncertain. OBJECTIVE: We sought to investigate recent time trends in socioeconomic disparities in cardiovascular disease (CVD) among persons with and without diabetes. PARTICIPANTS AND DESIGN: Two hundred fifty-five thousand nine hundred sixty-six individuals aged 25 years or older included in the National Health Interview Survey between 1997 and 2005. MEASUREMENTS: Educational attainment was used as a marker for SEP and self-reported history of CVD as the main outcome. Educational disparities were measured using prevalence rate ratios (PRR) and the relative index of inequalities (RII). MAIN RESULTS: Among adults with diabetes, CVD prevalence was persistently higher in those who did not complete high school (HS) than in college graduates (adjusted PRR [aPRR] 1.20, 95% confidence interval [95%CI] 1.05-1.38 in 1997-1999, and aPRR 1.12, 95% CI 1.00-1.25 in 2003-2005). However, the HS vs. college graduates disparity in CVD declined from 1997-1999 (aPRR 1.20, 95% CI 1.04-1.37) to 2003-2005 (aPRR 1.01, 95% CI 0.90-1.12). Among adults without diabetes educational disparities in CVD widened markedly over time. CONCLUSIONS: Concurrently with improvements in diabetes management, the widening of socioeconomic health disparities has remained limited in the diabetic population during the past decade. This provides evidence for the potential impact of improvements in disparities in health care access and process, such as experienced among persons with diabetes, in limiting socioeconomic health disparities.
BACKGROUND:Diabetes and its cardiovascular complications are more common in adults of low socioeconomic position (SEP). In the US, the past decade has seen the establishment of many programs to reduce cardiovascular risk in persons with diabetes, but their effect on socioeconomic disparities is uncertain. OBJECTIVE: We sought to investigate recent time trends in socioeconomic disparities in cardiovascular disease (CVD) among persons with and without diabetes. PARTICIPANTS AND DESIGN: Two hundred fifty-five thousand nine hundred sixty-six individuals aged 25 years or older included in the National Health Interview Survey between 1997 and 2005. MEASUREMENTS: Educational attainment was used as a marker for SEP and self-reported history of CVD as the main outcome. Educational disparities were measured using prevalence rate ratios (PRR) and the relative index of inequalities (RII). MAIN RESULTS: Among adults with diabetes, CVD prevalence was persistently higher in those who did not complete high school (HS) than in college graduates (adjusted PRR [aPRR] 1.20, 95% confidence interval [95%CI] 1.05-1.38 in 1997-1999, and aPRR 1.12, 95% CI 1.00-1.25 in 2003-2005). However, the HS vs. college graduates disparity in CVD declined from 1997-1999 (aPRR 1.20, 95% CI 1.04-1.37) to 2003-2005 (aPRR 1.01, 95% CI 0.90-1.12). Among adults without diabetes educational disparities in CVD widened markedly over time. CONCLUSIONS: Concurrently with improvements in diabetes management, the widening of socioeconomic health disparities has remained limited in the diabetic population during the past decade. This provides evidence for the potential impact of improvements in disparities in health care access and process, such as experienced among persons with diabetes, in limiting socioeconomic health disparities.
Authors: Giuseppina Imperatore; Betsy L Cadwell; Linda Geiss; Jinan B Saadinne; Desmond E Williams; Earl S Ford; Theodore J Thompson; K M Venkat Narayan; Edward W Gregg Journal: Am J Epidemiol Date: 2004-09-15 Impact factor: 4.897
Authors: Lisa A Cooper; L Ebony Boulware; Edgar R Miller; Sherita Hill Golden; Kathryn A Carson; Gary Noronha; Mary Margaret Huizinga; Debra L Roter; Hsin-Chieh Yeh; Lee R Bone; David M Levine; Felicia Hill-Briggs; Jeanne Charleston; Miyong Kim; Nae-Yuh Wang; Hanan Aboumatar; Jennifer P Halbert; Patti L Ephraim; Frederick L Brancati Journal: Am J Public Health Date: 2013-09-12 Impact factor: 9.308
Authors: Sherita Hill Golden; Arleen Brown; Jane A Cauley; Marshall H Chin; Tiffany L Gary-Webb; Catherine Kim; Julie Ann Sosa; Anne E Sumner; Blair Anton Journal: J Clin Endocrinol Metab Date: 2012-06-22 Impact factor: 5.958
Authors: Carl J Caspersen; G Darlene Thomas; Letia A Boseman; Gloria L A Beckles; Ann L Albright Journal: Am J Public Health Date: 2012-06-14 Impact factor: 9.308
Authors: Ans H Tiessen; Karin M Vermeulen; Jan Broer; Andries J Smit; Klaas van der Meer Journal: BMC Public Health Date: 2013-02-18 Impact factor: 3.295
Authors: Ans H Tiessen; Andries J Smit; Sebes Zevenhuizen; Edwin M Spithoven; Klaas Van der Meer Journal: BMC Fam Pract Date: 2012-12-10 Impact factor: 2.497