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Educational disparities in mortality among adults with diabetes in the U.S.
Dray-Spira R., Gary-Webb T. L., Brancati F. L.
Diabetes Care 33, 6 (2010) 1200-5 - http://www.hal.inserm.fr/inserm-00468713
 (20200302) 
Educational disparities in mortality among adults with diabetes in the U.S.
Rosemary Dray-Spira () 1, 2, Tiffany Gary-Webb2, Frederick Brancati2, 3
1:  Santé publique et épidémiologie des déterminants professionnels et sociaux de la santé
http://www.u687.idf.inserm.fr/
INSERM : U687 – IFR69 – Université Paris XI - Paris Sud – Université de Versailles Saint-Quentin-en-Yvelines
Hôpital Paul Brousse 16, av Paul Vaillant Couturier 94807 VILLEJUIF
France
2:  Department of Epidemiology
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD
United States
3:  Department of Medicine
Johns Hopkins University School of Medicine
Baltimore, MD
United States
Education and Mortality in US Diabetic Adults
OBJECTIVE: To measure relative and absolute educational disparities in mortality among U.S. adults with diabetes and to compare their magnitude with disparities observed within the nondiabetic population. RESEARCH DESIGN AND METHODS: A total of 85,867 individuals (5,007 with diabetes), aged 35-84 years, who participated in the National Health Interview Survey from 1986 to 1996 were followed for mortality through 31 December 2002. Relative and absolute educational disparities in all-cause, cardiovascular disease (CVD), and non-CVD mortality were measured. RESULTS: In relative terms, the risk of all-cause mortality was 28% higher in diabetic adults with the lowest versus the highest position on the educational scale (relative index of inequality 1.28 [95% CI 1.08-1.53]). This inverse relationship reflected marked disparities in CVD mortality and was found in all age, sex, and race/ethnicity groups except Hispanics. Although substantial, this relative educational gradient in mortality among adults with diabetes was smaller than in the nondiabetic population. In absolute terms, diabetic adults with the lowest position on the educational scale suffered 503 excess deaths per 10,000 person-years of follow-up compared with those with the highest position. These absolute disparities were stronger than in the nondiabetic population. The results were even more striking for CVD mortality. CONCLUSIONS: The risk of mortality differs substantially according to educational level among individuals with diabetes in the U.S. Although relative educational disparities in mortality are weaker in adults with versus without diabetes, their absolute impact is greater and translates into a major mortality burden.
Life Sciences/Health Care Sciences and Epidemiology
English
1935-5548

Article in peer-reviewed journal
10.2337/dc09-2094
Diabetes Care (Diabetes Care)
Publisher American Diabetes Association
ISSN 0149-5992 (eISSN : 0149-5992)
international
2010-06
2010-03-03
33
6
1200-5

Dr. Brancati is supported by the NIDDK Diabetes Research and Training Center (P60 DK079637).
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