Table 3. Morbidity (short- and long-term complications associated with type 1 diabetes).
| Study | Morbidity measures | Methods to assess SES | SES variable(s) | Key findings for adults with type 1 diabetes |
|---|---|---|---|---|
| Anderson et al. [14] | Painful neuropathy | Deprivation | ✔ g | Adjusted analysis: Each unit increase in deprivation score was associated with an increased risk of being prescribed medication for neuropathic pain (OR 1.11 (1.05–1.17), p <0.001). |
| Butalia et al. [15] | Ketoacidosis | Education* Income* |
x b x c |
Unadjusted and adjusted analysis: No association was found between hospitalisation for diabetic ketoacidosis (DKA) and either income or education. |
| Chaturvedi et al. [31] | Micro and macrovascular complications | Social class Education |
✔a ✔b | Unadjusted and adjusted analysis: Significantly lower rates of microalbuminuria and proliferative retinopathy were found for college educated men versus primary educated men. College education people were less likely to be smokers (p <0001). |
| Leese et al. [38] | Hypoglycaemia | Deprivation | ✔ g | Unadjusted analysis: Increasing deprivation was associated with severe hypoglycaemia (p <001). |
| Lievre et al. [39] | Complications, ketoacidosis, hypoglycaemia |
Social class | ✔f | Unadjusted analysis: Risk of having at least one complication was increased for each decrease in SES score. DKA was associated with SES score. Hypoglycaemia was not associated with SES. |
| Mühlhauser et al. [42] | Hypoglycaemia | Social class | ✔e | Adjusted analysis: Low SES was a statistically significant predictor of severe hypoglycaemia. |
| Mühlhauser et al. [43] | CVD risk factors, nephropathy | Social class | ✔e | Unadjusted analysis: Fewer adults of higher social status had either macrovascular complications or foot complications. An association between high SES and less likelihood of smoking was statistically significant. Adjusted analysis: High SES was associated with lower risk of nephropathy. |
| Mühlhauser et al. [44] | Microvascular complications | Social class | ✔d | Adjusted analysis: Low SES was significantly predictive of complications (a combination of blindness or amputations or renal replacement therapy) even after adjusting for other known risk factors. |
| Nadas et al. [16] | Cardiometabolic risk factors | Education | ✔b | Unadjusted analysis: Higher prevalence of metabolic syndrome and smoking were both associated with low versus high education. |
| Pederson- Bjergaard et al. [45] |
Hypoglycaemia | Education | ✔b | Unadjusted analysis: Primary school education was associated with a higher rate of hypoglycaemia. Adjusted analysis education was no longer associated with severe hypoglycaemia. |
| Rawshani et al. [18] | CVD events Non-fatal CHD |
Education Income |
✔b ✔c | Adjusted analysis: Individuals in the two lowest income quintiles had a two to three times higher risk of CVD events than those in the highest income quintile. Compared with low educational level having a high education was associated with approximately 30% lower risk of stroke. |
| Robinson et al. [47] | Risk factors for micro and macrovascular complications | Social class | ✔a | Unadjusted analysis: Differences between low and high SES were only observed amongst women with the latter smoking less and having a lower mean triglyceride level than the former. |
| Sastre et al. [19] | CVD risk factors | Education | ✔b | Unadjusted analysis: Low educational level or no primary education was associated with a greater prevalence of risk factors. |
| Secrest et al. [21] | Risk of complications including CHD events | Social class Education Income |
✔a ✔b ✔c | Unadjusted analysis: All complications (ESRD, CHD, LEAD and AN) were associated with at least one SES measure. Adjusted analysis: Following adjustments for other variables (including clinical risk factors) only the association between LEAD and income remained. Peripheral retinopathy was not associated with SES in either unadjusted or adjusted analysis. Smoking status was less common in high SES categories. |
| Unwin et al. [50] | CVD risk factors | Deprivation | ✔g | Unadjusted analysis: Increasing deprivation was significantly associated with mean serum cholesterol and smoking. |
| Weinstock et al. [22] | Ketoacidosis, hypoglycaemia | Education Income |
✔b ✔c | Adjusted analysis: Low SES (education and income) was associated with higher frequency in both DKA and severe hypoglycaemia. |
a Social class (occupation),
b Education,
c Income,
d Aggregate score of occupation and education,
e Aggregate score of occupation, education and income,
f Aggregate score of employment status, occupation, education and living alone,
g Area Deprivation score..
OR, odds ratio; CVD, cardiovascular disease; CHD, coronary heart disease; ESRD, end-stage renal disease; LEAD, lower-extremity artery disease; AN, autonomic neuropathy.
*Measured at neighbourhood level.