Socioeconomic Status, Modifiable Factors, and Risk of Microvascular Complications in Individuals With Type 2 Diabetes: A Cohort Study From the UK Biobank

IF 3.7 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Pub Date : 2025-04-02 DOI:10.1111/1753-0407.70079

Ying Li, Qiqi You, Menglin Fan, Lingqi Wei, Jingjing Zeng, Bo Chen, Jie Wang, Shaoyong Xu

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Abstract

Background

To investigate whether lower socioeconomic status (SES) was associated with an increased risk of diabetic microvascular complications and to analyze the potential mediating role of several modifiable factors.

Methods

The study included 11 309 patients with type 2 diabetes at baseline from the UK Biobank cohort. SES was grouped based on income, education, and employment status by using latent class analysis. Microvascular complications of diabetes were identified through electronic health records. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for microvascular complications across SES groups. Mediation analysis was applied to explore potential mediators in these associations.

Results

During a median follow-up of 12.2 years, 262, 764, and 1017 participants in the high, medium, and low SES groups were diagnosed with microvascular complications. Compared to participants with high SES, those with low SES had a HR of 1.75 (95% CI: 1.53, 2.01) for total microvascular complications, a HR of 2.11 (95% CI: 1.74, 2.55) for nephropathy, a HR of 1.40 (95% CI: 1.14, 1.72) for retinopathy, and a HR of 1.79 (95% CI: 1.32, 2.43) for neuropathy. Mediation analysis indicated that alcohol consumption, body mass index, triglycerides, high density lipoprotein cholesterol, and glycated hemoglobin mediated the association between SES and microvascular complications, with mediation percentages of 1.3%, 12.2%, 4.4%, 10.9%, and 10.8%, respectively.

Conclusions

Lower SES may be associated with a higher risk of diabetic microvascular complications, and obesity-related indicators and glycated hemoglobin may play important mediating roles in the association.

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2型糖尿病患者的社会经济地位、可改变因素和微血管并发症风险：来自英国生物银行的一项队列研究

背景：探讨低社会经济地位（SES）是否与糖尿病微血管并发症风险增加相关，并分析几种可调节因素的潜在中介作用。方法该研究纳入了1309例基线时来自英国生物银行队列的2型糖尿病患者。根据收入、教育程度和就业状况，采用潜在类别分析对SES进行分组。通过电子健康记录确定糖尿病微血管并发症。Cox回归模型用于估计SES组微血管并发症的风险比（hr）和95%置信区间（CIs）。应用中介分析来探索这些关联的潜在中介。结果在12.2年的中位随访期间，高、中、低SES组分别有262、764和1017名参与者被诊断出微血管并发症。与高SES的参与者相比，低SES的参与者的总微血管并发症的HR为1.75 (95% CI: 1.53, 2.01)，肾病的HR为2.11 (95% CI: 1.74, 2.55)，视网膜病变的HR为1.40 (95% CI: 1.14, 1.72)，神经病变的HR为1.79 （95% CI: 1.32, 2.43）。中介分析表明，饮酒、体重指数、甘油三酯、高密度脂蛋白胆固醇和糖化血红蛋白介导了SES与微血管并发症的关联，中介率分别为1.3%、12.2%、4.4%、10.9%和10.8%。结论SES越低，糖尿病微血管并发症发生风险越高，肥胖相关指标和糖化血红蛋白可能在其中起重要中介作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Diabetes ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

2.20%

发文量

审稿时长

>12 weeks

期刊介绍： Journal of Diabetes (JDB) devotes itself to diabetes research, therapeutics, and education. It aims to involve researchers and practitioners in a dialogue between East and West via all aspects of epidemiology, etiology, pathogenesis, management, complications and prevention of diabetes, including the molecular, biochemical, and physiological aspects of diabetes. The Editorial team is international with a unique mix of Asian and Western participation. The Editors welcome submissions in form of original research articles, images, novel case reports and correspondence, and will solicit reviews, point-counterpoint, commentaries, editorials, news highlights, and educational content.