Socioeconomic status, cardiovascular risk factors and the incidence of microvascular and macrovascular disease in type 1 diabetes
Swaminathan K., Lewis S., Morris AD., Belch J., Browning M., Campbell I., Carmichael C., Chalmers J., Chalmers L., Connacher A., Doig J., Dow E., Ferguson M., Fowle M., Fraser D., Gold A., Gray S., Hanning I., Hawthorne V., Holliday M., Jennings P., Jung R., Leese G., MacDonald M., MacLeod M., Matthews D., McBain A., McCullough D., McEwan S., McKnight J., Newton R., Patrick A., Peden N., Prescott R., Reith S., Roger J., Scott M., Siann T., Smith A., Thompson C., Walker J., Williamson J.
This study was undertaken to explore the associations between socioeconomic deprivation, prevalent cardiovascular risk factors and the development of microvascular and macrovascular complications in a cohort of subjects with type 1 diabetes mellitus in Scotland. We identified 2,314 people with type 1 diabetes from clinic records in six Scottish regions from 1989 to 1996. Postcode sectors were used to determine the Carstairs Index as a proxy for socioeconomic status. Clinic records and linkage to Scottish morbidity records allowed the association of socioeconomic status with the development of microvascular and macrovascular disease and the prevalence of cardiovascular risk factors to be evaluated. There was no overall association between prevalence of disease and socioeconomic status. There was a significant univariate relationship between smoking and deprivation (trend test p<0.00001; 47% of the most deprived were current smokers compared to 25% of the least deprived). Multivariate analysis showed that raised blood pressure, increasing age, smoking, high glycated haemoglobin and albuminuria were all independently associated with the development of macrovascular disease. Raised blood pressure, increasing duration of diabetes and high glycated haemoglobin were independently associated with microvascular disease. No associations were observed between either medical problem and socioeconomic status either before or after adjustment for other factors. Our study concluded that social deprivation is associated with an increased risk of smoking. Our results did not confirm a tendency to poor glycaemic or blood pressure control in people who are deprived and there was no association between deprivation and incident microvascular or macrovascular disease.