What is the clinical evidence from this study?

Study design: Cohort. Population: Diabetes mellitus (n=30541). Intervention: Higher household income vs. Lower household income. Primary outcome: Incident diabetic nephropathy (HR 0.80, 95% CI 0.75-0.85, p=<0.001).

January 20, 2025Diabetology & Metabolic Syndrome9 citationsOpen Access

Association of socioeconomic status with diabetic microvascular complications: a UK Biobank prospective cohort study

Q: What are the key findings of this study?

Higher household income was associated with a 20% reduced risk of incident diabetic nephropathy (HR 0.80) and diabetic peripheral neuropathy (HR 0.80) in adults with diabetes.

YHYikeng HuangShanghai Jiao Tong University ZZZhi ZhengHebei University of Chinese Medicine HCHaibing ChenNanjing Medical University

Key Result

Higher household income was associated with a 20% reduced risk of incident diabetic nephropathy (HR 0.80) and diabetic peripheral neuropathy (HR 0.80) in adults with diabetes.

Study Design

Type

Cohort (n=30,541)

Multicenter

Yes

Structured PICO

Does socioeconomic status affect the risk of developing diabetic microvascular complications?

Population

30,541 adults aged 37 to 73 years with diabetes from the UK Biobank, free of specific microvascular complications at baseline, followed for a median of 13 years.

Exposure

Higher socioeconomic status (evaluated by education attainment, household income, and Townsend deprivation index)

Comparator

Lower socioeconomic status

Outcome

Development of diabetic retinopathy (DR), diabetic nephropathy (DN), and diabetic peripheral neuropathy (DPN)hard clinical

Lower socioeconomic status is significantly associated with an increased risk of developing diabetic microvascular complications, highlighting the need for equitable healthcare resources.

Main Result

Hazard Ratio: 0.8 (95% CI 0.75–0.85)

p-value: p=<0.001

Limitations

Observational design cannot completely exclude residual and unmeasured confounders or mediators.
Lacks an overall socioeconomic status variable comprising different aspects of SES.
Reduced sample size in subgroup analyses may have limited statistical power.
Participants were mainly European, limiting generalizability to other populations.

Abstract

BACKGROUND: Prior studies on the link between socioeconomic status (SES) and diabetic microvascular complications have been inconclusive. This study aimed to explore whether SES is associated with the risk of diabetic retinopathy (DR), nephropathy (DN) and diabetic peripheral neuropathy (DPN) using large prospective cohort. METHODS: SES was evaluated using education attainment (individual level), household income (household level), and Townsend deprivation index (TDI, neighborhood level). This study included 28,339 participants without DR, 29,951 without DN and 29,762 without DPN at baseline from the UK Biobank. Weighted Cox proportional hazard models were used to investigate the relationship between SES and the risk of diabetic microvascular complications. RESULTS: The median follow-ups of the DR, DN and DPN cohorts were 12.95, 12.89 and 13.02 years, respectively. In total, 3,177 (11.2%) participants developed DR, 4,418 (14.8%) developed DN and 1,604 (5.4%) developed DPN. After adjusting for confounders, higher education levels (DN: hazard ratios HR = 0.85; 95% CI, 0.82-0.89; P < 0.001; DPN: HR = 0.93; 95% CI, 0.87-1.00; P = 0.040), higher household income (DN: HR = 0.80; 95% CI, 0.75-0.85; P < 0.001; DPN: HR = 0.80; 95% CI, 0.73-0.89; P < 0.001), and lower TDI (DN: HR = 1.19; 95% CI, 1.14-1.23; P < 0.001; DPN: HR = 1.27; 95% CI, 1.19-1.36; P < 0.001) were associated with a lower risk of DN and DPN. In contrast, a lower risk of DR was only related to higher household income (HR = 0.92; 95% CI, 0.87-0.97; P = 0.004) and lower TDI (HR = 1.08; 95% CI, 1.02-1.13; P = 0.004). CONCLUSIONS: Low SES increases the risk of diabetic microvascular complications, emphasizing the need for equitable medical resource allocation to reduce diabetes-related inequity.

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