Quality of Life Research

, Volume 23, Issue 4, pp 1337–1344 | Cite as

How do life-course trajectories of socioeconomic position affect quality of life in patients with diabetes mellitus?

  • Hye Ah Lee
  • Ko Eun Lee
  • Yool Won Jeong
  • Jaeseon Ryu
  • Minkyung Kim
  • Jung Won Min
  • Young Sun Hong
  • Kyunghee Jung-Choi
  • Hyesook Park



This study evaluated the association of life-course economic trajectory with health-related quality of life in patients with diabetes mellitus.


The study subjects were 183 outpatients over 20 years of age with diabetes mellitus. A questionnaire was administered to collect information about current and childhood economic status, and health-related quality of life was assessed through the 12-item short-form health survey (SF-12). Economic trajectory was categorized into five groups according to the change between current and childhood economic status. The mental component summary score and physical component summary score of the SF-12 were compared with average scores for the US population due to lack of domestic data.


Physical health-related quality of life was more likely to be affected by current economic status than by economic position in childhood. On the other hand, mental health-related quality of life was associated not only with the self-rated economic status (p = 0.01) but also socioeconomic trajectory (p = 0.04), even after controlling for potential confounding factors. These results suggest that early economic status may affect mental health throughout one’s lifetime.


Economic status and trajectory throughout life may influence health-related quality of life in patients with diabetes mellitus.


Trajectory Socioeconomic position Quality of life Diabetes mellitus 


Conflict of interest


Supplementary material

11136_2013_549_MOESM1_ESM.docx (81 kb)
Supplementary material 1 (DOCX 81 kb)


  1. 1.
    World Health Organization. (2002). Diabetes mellitus: The cost of diabetes. Fact sheet no. 236.Google Scholar
  2. 2.
    The Korea Centers for Disease Control and Prevention. (2011). 2008 Report on the Korea National Health and Nutrition Examination Survey, Republic of Korea. http://knhanes.cdc.go.kr. Accessed 11 May 2011.
  3. 3.
    Korean Diabetes Association and Korea Centers for Disease Control and Prevention. (2012). Diabetes fact sheet in Korea 2012. http://www.diabetes.or.kr/temp/Diabetes_Fact_sheet2012.pdf.
  4. 4.
    Chan, J. C., Malik, V., Jia, W., Kadowaki, T., Yajnik, C. S., Yoon, K. H., et al. (2009). Diabetes in Asia: Epidemiology, risk factors, and pathophysiology. Journal of the American Medical Association, 301(20), 2129–2140.PubMedCrossRefGoogle Scholar
  5. 5.
    Huxley, R., James, W. P., Barzi, F., Patel, J. V., Lear, S. A., Suriyawongpaisal, P., et al. (2008). Obesity in Asia Collaboration. Ethnic comparisons of the cross-sectional relationships between measures of body size with diabetes and hypertension. Obesity Reviews, 9(Suppl 1), 53–61.PubMedCrossRefGoogle Scholar
  6. 6.
    National Diabetes Information Clearinghouse. (2011). United States: http://diabetes.niddk.nih.gov/DM/PUBS/statistics/#fast. Accessed 3rd Oct 2011.
  7. 7.
    Centers for Disease Control and Prevention. (2011). 2011 National Diabetes Fact Sheet. United States: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf.
  8. 8.
    Am, Garrant., Schmidt, L., & Fitzpatrick, R. (2002). Patient-assessed health outcome measures for diabetes: A structured review. Diabetic Medicine, 19, 1–11.Google Scholar
  9. 9.
    Park, B. S., Jin, G. N., Choi, Y. C., Chung, J. H., Kim, K. H., Lee, M. Y., et al. (2005). Self-management and health-related quality of life in adolescent and adulthood diabetic patients. The Journal of Korean Diabetes Association, 29(3), 254–261.Google Scholar
  10. 10.
    Jackson, B., Kubzansky, L. D., Cohen, S., Weiss, S., Wright, R. J., & CARDIA Study. (2004). A matter of life and breath: Childhood socioeconomic status is related to young adult pulmonary function in the CARDIA study. International Journal of Epidemiology, 33, 271–278.PubMedCrossRefGoogle Scholar
  11. 11.
    Duncan, G., Yeung, W. J., Brooks-Gunn, J., & Smith, J. R. (1998). How much does childhood poverty affect the life chances of children? American Sociological Review, 63, 406–423.CrossRefGoogle Scholar
  12. 12.
    Bradley, R. H., & Corwyn, R. F. (2002). Socioeconomic status and child development. Annual Review of Psychology, 53, 371–399.PubMedCrossRefGoogle Scholar
  13. 13.
    Laforest, L., Bousquet, J., Neukirch, F., Aubier, M., Pietri, G., Devouassoux, G., et al. (2005). Influence of sociodemographic factors on quality of life during pollen season in seasonal allergic rhinitis patients. Annals of Allergy, Asthma & Immunology, 95, 26–32.CrossRefGoogle Scholar
  14. 14.
    Adler, N. E., & Ostrove, J. M. (1999). Socioeconomic status and health: What we know and what we don’t. Annals of the New York academy of Science, 896, 3–15.CrossRefGoogle Scholar
  15. 15.
    Park, B. H., Jung, M. S., & Lee, T. J. (2009). Associations of income and wealth with health status in the Korean elderly. Journal of Preventive Medicine and Public Health, 42, 275–282.PubMedCrossRefGoogle Scholar
  16. 16.
    Johnson, J. A., & Maddigan, S. L. (2004). Performance of the RAND-12 and SF-12 summary scores in type 2 diabetes. Quality of Life Research, 13, 449–456.PubMedCrossRefGoogle Scholar
  17. 17.
    Huurre, T., Aro, H., & Rahkonen, O. (2003). Well-being and health behaviour by parental socioeconomic status: A follow-up study of adolescents aged 16 until age 32 years. Social Psychiatry and Psychiatric Epidemiology, 38, 249–255.PubMedCrossRefGoogle Scholar
  18. 18.
    Lidfeldt, J., Li, T. Y., Hu, F. B., Manson, J. E., & Kawachi, I. (2007). A prospective study of childhood and adult socioeconomic status and incidence of type 2 diabetes in women. American Journal of Epidemiology, 165, 882–889.PubMedCrossRefGoogle Scholar
  19. 19.
    Kwan, J., Razzaq, A., Leiter, L. A., Lillie, D., & Hux, J. E. (2008). Low socioeconomic status and absence of supplemental health insurance as barriers to diabetes care access and utilization. Canadian Journal of Diabetes, 32, 174–181.CrossRefGoogle Scholar
  20. 20.
    McCall, D. T., Sauaia, A., Hamman, R. F., Reusch, J. E., & Barton, P. (2004). Are low income elderly patients at risk for poor diabetes care? Diabetes Care, 27, 1060–1065.PubMedCrossRefGoogle Scholar
  21. 21.
    Marin, T. J., Chen, E., & Miller, G. E. (2008). What do trajectories of childhood socioeconomic status tell us about markers of cardiovascular health in adolescence? Psychosomatic Medicine, 70, 152–159.PubMedCrossRefGoogle Scholar
  22. 22.
    Gustafsson, P. E., Janlert, U., Theorell, T., & Hammarström, A. (2010). Life-course socioeconomic trajectories and diurnal cortisol regulation in adulthood. Psychoneuroendocrinology, 35, 613–623.PubMedCrossRefGoogle Scholar
  23. 23.
    Kim, S. H., Hong, S. B., Suh, Y. J., Choi, Y. J., Nam, M., Lee, H. W., et al. (2012). Association between nutrient intake and obesity in type 2 diabetic patients from the Korean National Diabetes Program: a cross-sectional study. Journal of Korean Medical Science, 27(10), 1188–1195.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Kontodimopoulos, N., Pappa, E., Niakas, D., & Tountas, Y. (2007). Validity of SF-12 summary scores in a Greek general population. Health Qual Life Outcomes, 5, 55.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Larson, C. O., Schlundt, D., Patel, K., Beard, K., & Hargreaves, M. (2008). Validity of the SF-12 for use in a low-income African American community-based research initiative (REACH 2010). Preventing Chronic Disease, 5, A44.Google Scholar
  26. 26.
    Gandek, B., Ware, J. E., Aaronson, N. K., Apolone, G., Bjorner, J. B., Brazier, J. E., et al. (1998). Cross-validation of item selection and scoring for the SF-12 health survey in nine countries: Results from the IQOLA project. International quality of life assessment. Journal of Clinical Epidemiology, 51, 1171–1178.PubMedCrossRefGoogle Scholar
  27. 27.
    Utah Department of Health. (2008). United States: http://health.utah.gov/opha/publications/2001hss/sf12/SF12_Interpreting.pdf. Accessed 20 June. 2008.
  28. 28.
    Toobert, D. J., Hampson, S. E., & Glasgow, R. E. (2000). The summary of diabetes self-care activities measure: Results from 7 studies and a revised scale. Diabetes Care, 23, 943–950.PubMedCrossRefGoogle Scholar
  29. 29.
    Altman, D. G. (2006). Patrick Royston the cost of dichotomising continuous variables. British Medical Journal, 332(7549), 1080.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Eljedi, A., Mikolajczyk, R. T., Kraemer, A., & Laaser, U. (2006). Health-related quality of life in diabetic patients and controls without diabetes in refugee camps in the Gaza strip: A cross-sectional study. BMC Public Health, 6, 268.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Eom, Y. S., Yang, S. M., Oh, P. C., Lee, J. H., Lee, K. Y., Kim, Y. S., et al. (2008). Association of educational level and socioeconomic status with glucose metabolism. Korean Diabetes Journal, 32, 377–385.CrossRefGoogle Scholar
  32. 32.
    Rameswarapu, R., Bodhare, T. N., Bele, S. D., & Valsangkar, S. (2011). Social class differentiation and its impact on quality of life among diabetic patients. National Journal of Community Medicine, 2, 362–365.CrossRefGoogle Scholar
  33. 33.
    Hassan, K., Loar, R., Anderson, B. J., & Heptulla, R. A. (2006). The role of socioeconomic status, depression, quality of life, and glycemic control in type 1 diabetes mellitus. The Journal of Pediatrics, 149, 526–531.PubMedCrossRefGoogle Scholar
  34. 34.
    Brown, A. F., Ettner, S. L., Piette, J., Weinberger, M., Gregg, E., Shapiro, M. F., et al. (2004). Socioeconomic position and health among persons with diabetes mellitus: A conceptual framework and review of the literature. Epidemiologic Reviews, 26, 63–77.PubMedCrossRefGoogle Scholar
  35. 35.
    Ashing-Giwa, K. T., & Lim, J. W. (2009). Examining the impact of socioeconomic status and socioecologic stress on physical and mental health quality of life among breast cancer survivors. Oncology Nursing Forum, 36, 79–88.PubMedCrossRefGoogle Scholar
  36. 36.
    Smith, B. T., Lynch, J. W., Fox, C. S., Harper, S., Abrahamowicz, M., Almeida, N. D., et al. (2011). Life-course socioeconomic position and type 2 diabetes mellitus: The Framingham Offspring Study. American Journal of Epidemiology, 173, 438–447.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Matthews, K. A., Kiefe, C. I., Lewis, C. E., Liu, K., Sidney, S., & Yunis, C. (2002). Coronary artery risk development in young adults study (CARDIA). Socioeconomic trajectories and incident hypertension in a biracial cohort of young adults. Hypertension, 39, 772–776.PubMedCrossRefGoogle Scholar
  38. 38.
    Luo, Ye., & Linda, J. (2005). Waite the impact of childhood and adult SES on physical, mental, and cognitive well-being in later life. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 60(2), S93–S101.PubMedCentralCrossRefGoogle Scholar
  39. 39.
    Hanson, M. D., & Chen, E. (2007). Socioeconomic status and health behaviors in adolescence: A review of the literature. Journal of Behavioral Medicine, 30(3), 263–285.PubMedCrossRefGoogle Scholar
  40. 40.
    Yun, J. H., Kang, J. M., Kim, K. S., Kim, S. H., Kim, T. H., Park, Y. W., et al. (2004). Health-related quality of life in Korean patients with chronic diseases. Journal of Korean Rheumatism Association, 11, 263–274. (Korean).Google Scholar
  41. 41.
    Chung, J. Y., Lee, M. Y., & Kim, M. J. (2010). A study on the prevalence of chronic disease, health-related habits and nutrients intakes according to the quality of life in Korean Adults. Korean Journal of Community Nutrition, 15, 445–459. (Korean).Google Scholar
  42. 42.
    Hallqvist, J., Lynch, J., Bartley, M., Lang, T., & Blane, D. (2004). Can we disentangle life course processes of accumulation, critical period and social mobility? An analysis of disadvantaged socio-economic positions and myocardial infarction in the Stockholm Heart Epidemiology Program. Social Science and Medicine, 58, 1555–1562.PubMedCrossRefGoogle Scholar
  43. 43.
    Franzini, L., & Fernandez-Esquer, M. E. (2006). The association of subjective social status and health in low-income Mexican-origin individuals in Texas. Social Science and Medicine, 63(3), 788–804.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Hye Ah Lee
    • 1
  • Ko Eun Lee
    • 1
  • Yool Won Jeong
    • 1
  • Jaeseon Ryu
    • 1
  • Minkyung Kim
    • 1
  • Jung Won Min
    • 1
  • Young Sun Hong
    • 2
  • Kyunghee Jung-Choi
    • 1
  • Hyesook Park
    • 1
  1. 1.Department of Preventive Medicine, School of MedicineEwha Womans UniversitySeoulSouth Korea
  2. 2.Department of Internal Medicine, School of MedicineEwha Womans UniversitySeoulSouth Korea

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