Social class and risk factors for vascular disease in diabetes

Mortality statistics for England and Wales and for the U.S.A. indicate that death rates from diabetes mellitus are higher in the lower socioeconomic classes. In an attempt to explain this mortality difference, social-class differences in possible risk factors for the large- and small-vessel disease complications of diabetes have been examined in 95 insulin dependent diabetics (IDDs) and 79 non-insulin dependent diabetics (NIDDs) and comparative data obtained from 155 non-diabetic controls. Control males in the lower social class group were significantly shorter, more obese, smoked more and had lower Type A behaviour scores. Lower class female controls had significantly higher serum cholesterol levels. For the diabetic groups there were no social class differences in either fasting blood glucose levels or the prevalence of diabetic complications. Lower class NIDDs were significantly shorter and had lower Type A scores. This group also had higher mean cholesterol levels and smoked more, but these differences did not achieve statistical significance. Male IDDs showed no significant social class differences in possible risk factors but lower class females IDDs smoked more and had higher mean triglyceride levels. This concentration of risk factors for vascular disease in the diabetics of lower social class, particularly the NIDDs, may partly explain the increased mortality found in this group.