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Is Inflammation a Causal Chain between Low Socioeconomic Status and Type 2 Diabetes? Results from the KORA Survey 2000

  • Diabetes Mellitus
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Abstract

Low socioeconomic status (SES) is associated with type 2 diabetes. Inflammatory markers like C-reactive protein (CRP) are predictive of diabetes. It is unclear, whether inflammation may be a mechanism linking low SES to type 2 diabetes. In the population-based KORA Survey 2000, 766 men and 710 women aged 55 to 74 years were randomly selected in the Augsburg region (Southern Germany). An index for SES was defined using education, occupation, and income. In women but not in men, increased CRP concentrations were found with lower SES (p<0.01). This significant trend was no longer observed after adjusting for BMI and waist circumference (p=0.23). Low SES was significantly associated with the age-adjusted odds of having type 2 diabetes both in men (OR; 95%CI: 1.35; 1.14–1.60) and in women (2.01; 1.37–2.96). The risk of having diabetes associated with low SES was only slightly changed after adjusting for CRP, which was itself significantly related to diabetes. In multivariate analyses, adjusting for age, obesity, physical activity, smoking, alcohol intake, and CRP, low SES yielded only a borderline statistical significance in women (p=0.07), whereas no significant association with diabetes remained in men (p=0.14). After CRP was dropped from the full model, there was no change in the OR obtained for low SES (men: 1.30; 0.92–1.83; women: 1.54; 0.97–2.45). Low SES was not related to prediabetes (IFG, IGT), whereas CRP was significantly associated with diabetes precursors. In conclusion, inflammation appears not to play a major role linking low SES and type 2 diabetes in the elderly population.

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Abbreviations

CI:

confidence interval

CRP:

C reactive protein

KORA:

Cooperative Health Research in the Augsburg Region

OR:

odds ratio

SES:

socio-economic status

References

  1. JM Robbins V Vaccarino H Zhang SV Kasl (2001) ArticleTitleSocioeconomic status and type 2 diabetes in African American and Non-Hispanic white women and men: evidence from the Third National Health and Nutrition Examination Survey Am J Public Health 91 76–83 Occurrence Handle1:STN:280:DC%2BD3M%2FptlKgtQ%3D%3D Occurrence Handle11189829

    CAS  PubMed  Google Scholar 

  2. DL Leonetti CH Tsunehara PW Wahl WY Fujimoto (1992) ArticleTitleEducational attainment and the risk of non-insulin-dependent diabetes or coronary heart disease in Japanese-American men Ethn Dis 2 326–336 Occurrence Handle1:STN:280:ByyC2cvpvFM%3D Occurrence Handle1490129

    CAS  PubMed  Google Scholar 

  3. FL Brancati PK Whelton LH Kuller MJ Klag (1996) ArticleTitleDiabetes mellitus, race, and socio-economic status. A population-based study Ann Epidemiol 6 67–73 Occurrence Handle10.1016/1047-2797(95)00095-X Occurrence Handle1:STN:280:BymB1cvgtFE%3D Occurrence Handle8680628

    Article  CAS  PubMed  Google Scholar 

  4. M Tang Y Chen D Krewski (2003) ArticleTitleGender-related differences in the association between socioeconomic status and self-reported diabetes Int J Epidemiol 32 381–385 Occurrence Handle10.1093/ije/dyg075 Occurrence Handle12777423

    Article  PubMed  Google Scholar 

  5. BCK Choi F Shi (2001) ArticleTitleRisk factors for diabetes mellitus by age and sex: Results of the National Population Health Survey Diabetologia 44 1221–1231 Occurrence Handle10.1007/s001250100648 Occurrence Handle1:STN:280:DC%2BD3MnktVKisw%3D%3D Occurrence Handle11692170

    Article  CAS  PubMed  Google Scholar 

  6. C Green RD Hoppa TK Young JF Blanchard (2003) ArticleTitleGeographic analysis of diabetes prevalence in an urban area Soc Sci Med 57 551–560 Occurrence Handle12791496

    PubMed  Google Scholar 

  7. MG Marmot G Davey Smith S Stansfield et al. (1991) ArticleTitleHealth inequalities among British civil servants: the Whitehall II study Lancet 337 1387–1393 Occurrence Handle10.1016/0140-6736(91)93068-K Occurrence Handle1:STN:280:By6B2croslU%3D Occurrence Handle1674771

    Article  CAS  PubMed  Google Scholar 

  8. V Connolly N Unwin P Sherriff R Bilous W Kelly (2000) ArticleTitleDiabetes prevalence and socioeconomic status: A population based study showing increased prevalence of type 2 diabetes mellitus in deprived areas J Epidemiol Community Health 54 173–177 Occurrence Handle1:STN:280:DC%2BD3c3htVajtw%3D%3D Occurrence Handle10746110

    CAS  PubMed  Google Scholar 

  9. AA Ismail NJ Beeching GV Gill MA Bellis (1999) ArticleTitleCapture–recapture-adjusted prevalence rates of type 2 diabetes are related to social deprivation Q J Med 92 707–710 Occurrence Handle1:STN:280:DC%2BD3c7htlSqsQ%3D%3D

    CAS  Google Scholar 

  10. JM Evans RW Newton DA Ruta TM MacDonald AD Morris (2000) ArticleTitleSocio-economic status, obesity and prevalence of Type 1 and Type 2 diabetes mellitus Diabet Med 17 478–480 Occurrence Handle10.1046/j.1464-5491.2000.00309.x Occurrence Handle1:STN:280:DC%2BD3M%2FmsF2nsQ%3D%3D Occurrence Handle10975218

    Article  CAS  PubMed  Google Scholar 

  11. DL Whitford SJ Griffin AT Prevost (2003) ArticleTitleInfluences on the variation in prevalence of type 2 diabetes between practices: practice, patient or socioeconomic factors? Br J Gen Pract 53 9–14 Occurrence Handle12564271

    PubMed  Google Scholar 

  12. K Hjelm A Isacsson J Apelqvist J Sundquist P Nyberg (1996) ArticleTitleForeign and Swedish-born diabetic patients-a population-based study of prevalence, glycaemic control and social position Scand J Soc Med 24 234–252

    Google Scholar 

  13. JP Mackenbach CW Looman JBW Meer Particlevan der (1996) ArticleTitleDifferences in the misreporting of chronic conditions, by level of education: The effect on inequalities in prevalence rates Am J Public Health 86 706–711 Occurrence Handle1:STN:280:BymB3M3js1I%3D Occurrence Handle8629723

    CAS  PubMed  Google Scholar 

  14. H Knopf U Ellert HU Melchert (1999) ArticleTitleSocial strata and health (in German) Gesundheitswesen 61 S169–S177 Occurrence Handle10726417

    PubMed  Google Scholar 

  15. U Helmert HU Janka H Strube (1994) ArticleTitleEpidemiologic findings for diabetes mellitus prevalence in the Federal Republic of Germany between 1984 and 1991 (in German) Diabetes Stoffwechsel 3 271–277

    Google Scholar 

  16. JC Pickup (2004) ArticleTitleInflammation and activated innate immunity in the pathogenesis of type 2 diabetes Diabetes Care 27 813–823 Occurrence Handle14988310

    PubMed  Google Scholar 

  17. P Jousilahti V Salomaa V Rasi E Vahtera T Palosuo (2003) ArticleTitleAssociation of markers of systemic inflammation, C reactive protein, serum amyloid A, and fibrinogen, with socio-economic status J Epidemiol Community Health 57 730–733 Occurrence Handle1:STN:280:DC%2BD3svitFCjtg%3D%3D Occurrence Handle12933781

    CAS  PubMed  Google Scholar 

  18. H Hemingway M Shipley MJ Mullen et al. (2003) ArticleTitleSocial and psychosocial influences on inflammatory markers and vascular function in civil servants (the Whitehall II Study) Am J Cardiol 92 984–987 Occurrence Handle10.1016/S0002-9149(03)00985-8 Occurrence Handle1:CAS:528:DC%2BD3sXnvVOhs7o%3D Occurrence Handle14556880

    Article  CAS  PubMed  Google Scholar 

  19. N Owen T Poulton FC Hay V Mohamed-Ali A Steptoe (2003) ArticleTitleSocioeconomic status, C-reactive protein, immune factors, and response to acute mental stress Brain Behav Immun 17 286–295 Occurrence Handle10.1016/S0889-1591(03)00058-8 Occurrence Handle1:CAS:528:DC%2BD3sXkvVCgsbo%3D Occurrence Handle12831831

    Article  CAS  PubMed  Google Scholar 

  20. Rathmann W, Haastert B, Icks A, et al. Sex differences in the association of socioeconomic status with undiagnosed diabetes mellitus and impaired glucose tolerance in the elderly population: the KORA Survey 2000. Eur J Publ Health 2005; Jul 28 [Epub ahead of print]

  21. B Thorand H Lowel A Schneider et al. (2003) ArticleTitleC-reactive protein as a predictor for incident diabetes mellitus among middle-aged men: results from the MONICA Augsburg cohort study, 1984–1998 Arch Intern Med 163 93–99 Occurrence Handle10.1001/archinte.163.1.93 Occurrence Handle1:CAS:528:DC%2BD3sXhtVyktL8%3D Occurrence Handle12523922

    Article  CAS  PubMed  Google Scholar 

  22. W Rathmann B Haastert A Icks et al. (2003) ArticleTitleHigh prevalence of undiagnosed diabetes mellitus in Southern Germany: target populations for efficient screening. The KORA survey 2000 Diabetologia 46 182–189 Occurrence Handle1:STN:280:DC%2BD3s7htlaisA%3D%3D Occurrence Handle12627316

    CAS  PubMed  Google Scholar 

  23. KGMM Alberti (1998) ArticleTitleZimmet PZ for the WHO Consultation. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus. Provisional report of a WHO consultation Diabet Med 15 539–553 Occurrence Handle1:STN:280:DyaK1czkvFCrsA%3D%3D Occurrence Handle9686693

    CAS  PubMed  Google Scholar 

  24. U Helmert S Shea (1994) ArticleTitleSocial inequalities and health status in Western Germany Public Health 108 341–356 Occurrence Handle10.1016/S0033-3506(05)80070-8 Occurrence Handle1:STN:280:ByqD283ovF0%3D Occurrence Handle7972675

    Article  CAS  PubMed  Google Scholar 

  25. U Helmert S Shea U Maschewsky-Schneider (1995) ArticleTitleSocial class and cardiovascular disease risk factor changes in West Germany 1984–1991 Eur J Publ Health 5 103–108

    Google Scholar 

  26. A Mielck (2000) Soziale Ungleichheit und Gesundheit: Empirische Ergebnisse, Erklärungsansätze, Interventionsmöglichkeiten Verlag Hans Huber Bern

    Google Scholar 

  27. EE Agardh A Ahlbom T Andersson et al. (2004) ArticleTitleExplanations of socioeconomic differences in excess risk of type 2 diabetes in Swedish men and women Diabetes Care 27 716–721 Occurrence Handle14988291

    PubMed  Google Scholar 

  28. N Unwin J Shaw P Zimmet KG Alberti (2002) ArticleTitleImpaired glucose tolerance and impaired fasting glycaemia: The current status on definition and intervention Diabet Med 19 708–723 Occurrence Handle1:STN:280:DC%2BD38vltlaluw%3D%3D Occurrence Handle12207806

    CAS  PubMed  Google Scholar 

  29. TW Wilson GA Kaplan J Kauhanen et al. (1993) ArticleTitleAssociation between plasma fibrinogen concentration and five socioeconomic indices in the Kuopio Ischemic Heart Disease Risk Factor Study Am J Epidemiol 137 292–300 Occurrence Handle1:STN:280:ByyC1Mfoslc%3D Occurrence Handle8452137

    CAS  PubMed  Google Scholar 

  30. J Wardle J Waller MJ Jarvis (2002) ArticleTitleSex differences in the association of socioeconomic status with obesity Am J Public Health 92 1299–1304 Occurrence Handle12144988

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute at the Heinrich-Heine-University, Düsseldorf, Germany

    Wolfgang Rathmann, Burkhard Haastert & Guido Giani

  2. The University of Ulm Medical Center, Ulm, Germany

    Wolfgang Koenig & Armin Imhof

  3. German Diabetes Clinic, German Diabetes Center at Düsseldorf University, Germany

    Christian Herder

  4. Institute of Health Economics and Health Care Management, National Research Center for Environment and Health, Neuherberg, Germany

    Rolf Holle & Andreas Mielck

Authors
  1. Wolfgang Rathmann
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  2. Burkhard Haastert
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  3. Guido Giani
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  4. Wolfgang Koenig
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  5. Armin Imhof
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  6. Christian Herder
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  7. Rolf Holle
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  8. Andreas Mielck
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Correspondence to Wolfgang Koenig.

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Rathmann, W., Haastert, B., Giani, G. et al. Is Inflammation a Causal Chain between Low Socioeconomic Status and Type 2 Diabetes? Results from the KORA Survey 2000. Eur J Epidemiol 21, 55–60 (2006). https://doi.org/10.1007/s10654-005-5085-6

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  • DOI: https://doi.org/10.1007/s10654-005-5085-6

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