Socioeconomic differences in mortality among diabetic people in Finland

Abstract

Aims: A clear socioeconomic gradient in mortality emerged among diabetic people in Finland from the early 1980s to the early 1990s. The present study examines whether this development continued between 1991 and 2003. Methods: People with diabetes aged 30—79 in 1991—2002 were identified in the national registers, and followed up for mortality until 31 December 2003. The data comprised 1,407,025 person years and 59,917 deaths. Results: From 1991—1994 to 1995—1999, the all-cause mortality among diabetic people decreased 20% for men and 26% for women among non-manual workers compared with 14% and 19% respectively among manual workers. The socioeconomic differences increased particularly in mortality from coronary heart disease and causes related to smoking and excessive alcohol use. From 1995—1999 to 2000—2003 the socioeconomic mortality disparity remained stable except for emerging socioeconomic differences in neoplasm deaths among women. Persons with type 1 diabetes showed much larger socioeconomic differences in deaths from alcohol related diseases (RR: men 1.97, women 2.13) compared to persons with type 2 diabetes (RR: men 1.20, women 1.05). Conclusions: During the 1990s disparities in mortality between socioeconomic groups among diabetic people increased due to a more favourable trend among non-manual workers compared to manual workers in deaths from coronary heart disease and causes of death related to smoking and excessive alcohol use. From the late 1990s to 2000—2003, inequality in mortality remained stable except for emerging socioeconomic differences in neoplasm deaths among women.

Keywords

Diabetes mellitus mortality register study socioeconomic factors

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References

Chaturvedi N. , Jarrett J. , Shipley MJ , Fuller JH Socioeconomic gradient in morbidity and mortality in people with diabetes: cohort study findings from the Whitehall Study and the WHO Multinational Study of Vascular Disease in Diabetes. BMJ 1998;316(7125):100-5.

Robinson N. , Lloyd CE , Stevens LK Social deprivation and mortality in adults with diabetes mellitus. Diabet Med 1998;15(3):205-12.

Roper NA , Bilous RW , Kelly WF , Unwin NC , Connolly VM Excess mortality in a population with diabetes and the impact of material deprivation: longitudinal, population based study. BMJ 2001;322(7299):1389-93.

Gnavi R. , Petrelli A. , Demaria M. , Spadea T. , Carta Q. , Costa G. Mortality and educational level among diabetic and non-diabetic population in the Turin Longitudinal Study: a 9-year follow-up. Int J Epidemiol 2004;33(4):864-71.

Koskinen SV , Martelin TP , Valkonen T. Socioeconomic differences in mortality among diabetic people in Finland: five year follow up. BMJ 1996;313(7063):975-8.

Forssas E. , Keskimäki I. , Reunanen A. , Koskinen S. Widening socioeconomic mortality disparity among diabetic people in Finland. Eur J Public Health 2003;13(1):38-43.

Chaturvedi N.

Commentary: Socioeconomic status and diabetes outcomes; what might we expect and why don’t we find it?

Int J Epidemiol 2004;33(4):871-3.

Cho E. , Rimm EB , Stampfer MJ , Willett WC , Hu FB The impact of diabetes mellitus and prior myocardial infarction on mortality from all causes and from coronary heart disease in men. J Am Coll Cardiol 2002;40(5):954-60.

Haffner SM , Lehto S. , Rönnemaa T. , Pyörälä K. , Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339(4):229-34.

10.

Nilsson PM , Johansson SE , Sundquist J. Low educational status is a risk factor for mortality among diabetic people. Diabet Med 1998;15(3):213-19.

11.

Mäkelä P. , Valkonen T. , Martelin T. Contribution of deaths related to alcohol use to socioeconomic variation in mortality: register based follow up study . BMJ 1997; 315(7102):211-16.

12.

Hemström Ö. Alcohol-related deaths contribute to socioeconomic differentials in mortality in Sweden. Eur J Public Health 2002;12(4):254-62.

13.

Siahpush M. , English D. , Powles J. The contribution of smoking to socioeconomic differentials in mortality: results from the Melbourne Collaborative Cohort Study, Australia. J Epidemiol Community Health 2006;60(12):1077-9.

14.

Niemi M. , Winell K. Diabetes in Finland. Prevalence and variations in quality of care. Tampere: Finnish Diabetes Association; 2006.

15.

Valkonen T. , Martelin T. , Rimpelä A. Socio-economic mortality differences in Finland 1971-85. Helsinki: Central Statistical Office of Finland; 1990.

16.

Townsend P. , Davidson N. , Whitehead M. Inequalities in health and the health divide: the Black report. London: Penguin; 1988.

17.

Valkonen T. , Martikainen P. , Remes H. Sosiaaliryhmien väliset elinajanodote-erot ovat pysyneet suurina 2000-luvulla [Trends in life expectancies among different social groups up to 2005]. Suom Lääkäril [Finnish Medical Journal] 2007;62(42):3891-6.

18.

Salmela R. , Koistinen V. Yleissairaaloiden poistoilmoitusrekisterin kattavuus ja luotettavuus [Is the discharge register of general hospitals complete and reliable?]. Sairaala 1987; 49:480-2.

19.

Lahti RA , Sarna S. , Penttila A. Exploitation of autopsy in determining natural cause of death: trends in Finland with special reference to the diagnostics of ischemic heart diseases and cerebrovascular diseases in middle-aged males, 1974-1993. Forensic Sci Int 1998;91(2):109-21.

20.

Valkonen T. , Martikainen P. Trends in life expectancy by level of education and occupational social class in Finland 1981-2000. Finnish Yearbook of Population Research 2006; 42:27-42.

21.

Kokkonen J. , Paavilainen T.

Pitkäaikaissairaiden nuorten tupakointi [Smoking among young adults with a chronic disease]

Suom Lääkäril [Finnish Medical Journal] 1993;48(5):384.

22.

Wibell L. , Nyström L. , Östman J. , Arnqvist H. , Blohme G. , Lithner F. , et al. Increased mortality in diabetes during the first 10 years of the disease. A population-based study (DISS) in Swedish adults 15-34 years old at diagnosis. J Int Med 2001;249(3):263-70.

23.

Gulliford MC , Sedgwick JE , Pearce AJ Cigarette smoking, health status, socio-economic status and access to health care in diabetes mellitus: a cross-sectional survey . BMC Health Serv Res 2003;3(1):4.

24.

Kinsey T. , Jemal A. , Lift J. , Ward E. , Thun M. Secular trends in mortality from common cancers in the United States by educational attainment, 1993-2001. J Natl Cancer Inst 2008;100(14):1003-12.