Antonio Escolar-Pujolar1, Juan Antonio Córdoba Doña2, Isabel Goicolea Julían3, Gabriel Jesús Rodríguez4, Vanesa Santos Sánchez5, Eduardo Mayoral Sánchez6, Manuel Aguilar Diosdado7. 1. Consejería de Salud de la Junta de Andalucía, Delegación Territorial en Cádiz, Cádiz, España. Electronic address: antonio.escolar@uca.es. 2. Consejería de Salud de la Junta de Andalucía, Delegación Territorial en Cádiz, Cádiz, España. 3. Department of Public Health and Clinical Medicine, Umeå University, Umeå, Suecia. 4. École des Hautes Études en Sciences Sociales (EHESS), París, Francia. 5. Dipartamenti di Scienze Economiche e Aziendali, Università degli Studi di Sassari, Sassari, Cerdeña, Italia. 6. Consejería de Salud de la Junta de Andalucía, Plan Andaluz de Diabetes, Sevilla, España. 7. Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Servicio Andaluz de Salud, Cádiz, España.
Abstract
OBJECTIVE: To assess the modifying effect of marital status on social and gender inequalities in mortality from diabetes mellitus (DM) in Andalusia. MATERIAL AND METHODS: A cross-sectional study was conducted using the Andalusian Longitudinal Population Database. DM deaths between 2002 and 2013 were analyzed by educational level and marital status. Age-adjusted rates (AARs) and mortality rate ratios (MRRs) were calculated using Poisson regression models, controlling for several social and demographic variables. The modifying effect of marital status on the association between educational level and DM mortality was evaluated by introducing an interaction term into the models. All analyses were performed separately for men and women. RESULTS: There were 18,158 DM deaths (10,635 women and 7,523 men) among the 4,229,791 people included in the study. The risk of death increased as the educational level decreased. Marital status modified social inequality in DM mortality in a different way in each sex. Widowed and separated/divorced women with the lowest educational level had the highest MRRs, 5,1 (95%CI: 3,6-7,3) and 5,6 (95% CI:3,6-8,5) respectively, while single men had the highest MRR, 3,1 (95%CI: 2,7-3,6). CONCLUSIONS: Educational level is a key determinant of DM mortality in both sexes, and is more relevant in women, while marital status also plays an outstanding role in men. Our results suggest that in order to address inequalities in DM mortality, the current focus on individual factors and self-care should be extended to interventions on the family, the community, and the social contexts closest to patients.
OBJECTIVE: To assess the modifying effect of marital status on social and gender inequalities in mortality from diabetes mellitus (DM) in Andalusia. MATERIAL AND METHODS: A cross-sectional study was conducted using the Andalusian Longitudinal Population Database. DM deaths between 2002 and 2013 were analyzed by educational level and marital status. Age-adjusted rates (AARs) and mortality rate ratios (MRRs) were calculated using Poisson regression models, controlling for several social and demographic variables. The modifying effect of marital status on the association between educational level and DM mortality was evaluated by introducing an interaction term into the models. All analyses were performed separately for men and women. RESULTS: There were 18,158 DM deaths (10,635 women and 7,523 men) among the 4,229,791 people included in the study. The risk of death increased as the educational level decreased. Marital status modified social inequality in DM mortality in a different way in each sex. Widowed and separated/divorced women with the lowest educational level had the highest MRRs, 5,1 (95%CI: 3,6-7,3) and 5,6 (95% CI:3,6-8,5) respectively, while single men had the highest MRR, 3,1 (95%CI: 2,7-3,6). CONCLUSIONS: Educational level is a key determinant of DM mortality in both sexes, and is more relevant in women, while marital status also plays an outstanding role in men. Our results suggest that in order to address inequalities in DM mortality, the current focus on individual factors and self-care should be extended to interventions on the family, the community, and the social contexts closest to patients.
Keywords:
Desigualdades; Diabetes mellitus; Educational level; Estado civil; Gender; Género; Inequalities; Marital status; Mortalidad; Mortality; Nivel de estudios
Authors: Kristina Laugesen; Lisbeth Munksgård Baggesen; Sigrún Alba Jóhannesdóttir Schmidt; M Maria Glymour; Mathias Lasgaard; Arnold Milstein; Henrik Toft Sørensen; Nancy E Adler; Vera Ehrenstein Journal: Sci Rep Date: 2018-03-16 Impact factor: 4.379