Socioeconomic differences in mortality among diabetic people in Finland

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.