Lower educational level is a predictor of incident type 2 diabetes in European countries: The EPIC-InterAct study

被引：126

作者：

Sacerdote, Carlotta ^{[1
,2
]}

Ricceri, Fulvio ^{[2
]}

Rolandsson, Olov ^{[3
]}

Baldi, Ileana ^{[4
]}

Chirlaque, Maria-Dolores ^{[5
]}

Feskens, Edith ^{[6
]}

Bendinelli, Benedetta ^{[7
]}

Ardanaz, Eva ^{[8
]}

Arriola, Larraitz ^{[9
]}

Balkau, Beverley ^{[10
]}

Bergmann, Manuela ^{[11
]}

Beulens, Joline W. J. ^{[12
]}

Boeing, Heiner ^{[11
]}

Clavel-Chapelon, Francoise ^{[10
]}

Crowe, Francesca ^{[13
]}

de Lauzon-Guillain, Blandine ^{[10
]}

Forouhi, Nita ^{[14
]}

Franks, Paul W. ^{[3
,15
,16
,17
]}

Gallo, Valentina ^{[18
]}

Gonzalez, Carlos ^{[19
]}

Halkjaer, Jytte ^{[20
]}

Illner, Anne-Kathrin ^{[21
]}

Kaaks, Rudolf ^{[22
]}

Key, Timothy ^{[13
]}

Khaw, Kay-Tee ^{[23
]}

Navarro, Carmen ^{[5
,24
]}

Nilsson, Peter M. ^{[12
]}

Dalton, Susanne Oksbjerg ^{[25
]}

Overvad, Kim ^{[26
]}

Pala, Valeria ^{[27
]}

Palli, Domenico ^{[7
]}

Panico, Salvatore ^{[28
]}

Polidoro, Silvia ^{[2
]}

Ramon Quiros, J. ^{[29
]}

Romieu, Isabelle ^{[30
]}

Sanchez, Maria-Jose ^{[31
]}

Slimani, Nadia ^{[30
]}

Sluijs, Ivonne ^{[12
]}

Spijkerman, Annemieke ^{[32
]}

Teucher, Birgit ^{[22
]}

Tjonneland, Anne ^{[20
]}

Tumino, Rosario ^{[33
]}

van der A, Daphne ^{[32
]}

Vergnaud, Anne-Claire

Wennberg, Patrik ^{[3
]}

Sharp, Stephen ^{[34
]}

Langenberg, Claudia ^{[34
]}

Riboli, Elio ^{[35
]}

Vineis, Paolo ^{[2
,36
]}

Wareham, Nicholas ^{[34
]}

机构：

[1] Ctr Canc Prevent CPO Piemonte, Turin, Italy

[2] Human Genet Fdn HuGeF, Turin, Italy

[3] Umea Univ, Dept Publ Hlth & Clin Med, S-90187 Umea, Sweden

[4] Univ Padua, Dept Environm Med & Publ Hlth, I-35100 Padua, Italy

[5] Murcia Reg Hlth Author, Murcia, Spain

[6] Univ Wageningen, Div Human Nutr, Sect Nutr & Epidemiol, Wageningen, Netherlands

[7] Canc Res & Prevent Inst ISPO, Mol & Nutr Epidemiol Unit, Florence, Italy

[8] Navarre Publ Hlth Inst, Pamplona, Spain

[9] Basque Govt, Publ Hlth Dept Gipuzkoa, San Sebastian, Spain

[10] Paris S Univ, Villejuif, France

[11] German Inst Human Nutr Potsdam Rehbrucke, Dept Epidemiol, Nuthetal, Germany

[12] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands

[13] Univ Oxford, Nuffield Dept Clin Med, Canc Epidemiol Unit, Oxford OX1 2JD, England

[14] Addenbrookes Hosp, Inst Metab Sci, MRC Epidemiol Unit, Cambridge, England

[15] Lund Univ, Ctr Diabet, Malmo, Sweden

[16] Umea Univ, Dept Publ Hlth & Clin Med, S-90187 Umea, Sweden

[17] Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA

[18] London Sch Hyg & Trop Med, London, England

[19] ICO, Unit Nutr Environm & Canc, Barcelona, Spain

[20] Danish Canc Soc Res Ctr, Copenhagen, Denmark

[21] German Inst Human Nutr, Dept Epidemiol, Bergholz Rehbrucke, Germany

[22] German Canc Res Ctr, Div Canc Epidemiol, D-6900 Heidelberg, Germany

[23] Addenbrookes Hosp, Dept Clin Gerontol, Cambridge, England

[24] Sch Med, Unit Prevent Med & Publ Hlth, Murcia, Spain

[25] Danish Canc Soc, Inst Canc Epidemiol, Dept Psychosocial Canc Res, Copenhagen, Denmark

[26] Aarhus Univ, Sch Publ Hlth, Dept Epidemiol, Aaarhus, Denmark

[27] Fdn IRCCS Ist Nazl Tumori, Dept Prevent & Predict Med, Nutr Epidemiol Unit, Milan, Italy

[28] Univ Naples Federico II, Dept Clin & Expt Med, Naples, Italy

[29] Asturias Hlth & Hlth Care Council, Oviedo, Spain

[30] Int Agcy Res Canc, Dietary Exposure Assessment Grp, F-69372 Lyon, France

[31] Andalusian Sch Publ Hlth, Granada, Spain

[32] Natl Inst Publ Hlth & Environm, Ctr Prevent & Hlth Serv Res, NL-3720 BA Bilthoven, Netherlands

[33] Civile MP Arezzo Hosp, Canc Registry & Histopathol Unit, Ragusa, Italy

[34] Addenbrookes Hosp, MRC Epidemiol Unit, Inst Metab Sci, Cambridge, England

[35] Univ London Imperial Coll Sci Technol & Med, Sch Publ Hlth, Dept Epidemiol & Biostat, London, England

[36] Univ London Imperial Coll Sci Technol & Med, Sch Publ Hlth, MRC HPA Ctr Environm & Hlth, London, England

来源：

INTERNATIONAL JOURNAL OF EPIDEMIOLOGY | 2012年 / 41卷 / 04期

基金：

瑞典研究理事会;

关键词：

T2DM; education; socio-economic status; relative index of inequality; cohort studies; epidemiologic research design; COURSE SOCIOECONOMIC POSITION; 3RD NATIONAL-HEALTH; RISK-FACTORS; CARDIOVASCULAR-DISEASE; SOCIAL-CLASS; SWEDISH MEN; INEQUALITIES; MELLITUS; CHILDHOOD; MORTALITY;

D O I：

10.1093/ije/dys091

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

Background Type 2 diabetes mellitus ( T2DM) is one of the most common chronic diseases worldwide. In high- income countries, low socioeconomic status seems to be related to a high incidence of T2DM, but very little is known about the intermediate factors of this relationship. Method We performed a case-cohort study in eight Western European countries nested in the EPIC study (n = 340 234, 3.99 million person-years of follow-up). A random sub-cohort of 16 835 individuals and a total of 12 403 incident cases of T2DM were identified. Crude and multivariate-adjusted hazard ratios (HR) were estimated for each country and pooled across countries using meta-analytical methods. Age-, gender- and country-specific relative indices of inequality (RII) were used as the measure of educational level and RII tertiles were analysed. Results Compared with participants with a high educational level (RII tertile 1), participants with a low educational level (RII tertile 3) had a higher risk of T2DM [HR: 1.77, 95% confidence interval (CI): 1.69-1.85; P-trend < 0.01]. The HRs adjusted for physical activity, smoking status and propensity score according to macronutrient intake were very similar to the crude HR (adjusted HR: 1.67, 95% CI: 1.52-1.83 in men; HR: 1.88, 95% CI: 1.73-2.05 in women). The HRs were attenuated only when they were further adjusted for BMI (BMI-adjusted HR: 1.36, 95% CI: 1.23-1.51 in men; HR: 1.32, 95% CI: 1.20-1.45 in women). Conclusion This study demonstrates the inequalities in the risk of T2DM in Western European countries, with an inverse relationship between educational level and risk of T2DM that is only partially explained by variations in BMI.

引用

页码：1162 / 1173

页数：12

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