Low educational status is a risk factor for mortality among diabetic people

Diabetes mellitus and its complications are an important cause of mortality in Western populations. The purpose of the present study was to examine the relationship between self-reported diabetes mellitus, gender, attained level of education, and socio-economic resources to all-cause mortality risk in a simple random sample of 39055 subjects, aged 25 to 74 years. Follow-up data were obtained for a maximum of 16 years, from baseline (1979-1985) to 31 December 1995. Diabetic males (2.2% of the male study group) had a relative risk (RR) for total mortality of 2.24 (CI = 1.96-2.57), adjusted for age, education, marital status, housing tenure, and car ownership, compared with non-diabetic males. The corresponding figure for females with diabetes (1.9%) was RR = 3.67 (CI = 3.16-4.27). Diabetic women had the highest age-adjusted mortality risk for coronary heart disease (CHD) of 8 compared with non-diabetic women. The corresponding RR for men was just below 3 (p<0.0001). Males and females (with and without diabetes) of low attained educational level had a RR = 1.26 (CI = 1.15-1.39) and RR = 1.54 (CI = 1.31-1.81), respectively. When analysing all people with diabetes separately, adjusting for sex and age, low-educated subjects had a 40% excess all-cause mortality compared with high-educated subjects. We conclude that diabetic women have a very high relative risk for CHD mortality compared to non-diabetic women. Furthermore, diabetic people with a low attained level of education, have an increased vulnerability to, and a higher total mortality.