根据美国成年人糖尿病状况,教育状况与死亡率之间的关联
Toshiaki Komura1, Naoki Kondo2,3, Karan Bhatt4
1Department of Epidemiology, Boston University School of Public Health, MA.
Mayo Clinic proceedings. Innovations, quality & outcomes
|June 12, 2023
概括
教育程度较低会增加死亡风险,尤其是糖尿病患者. 糖尿病的存在,即使没有糖尿病视网膜病变 (DR),也显著扩大了这一差距,强调了预防糖尿病的必要性,以减少健康差异.
科学领域:
- 公共卫生 公共卫生
- 流行病学 流行病学
- 健康的社会经济决定因素
背景情况:
- 教育程度是健康的关键社会决定因素.
- 糖尿病及其并发症糖尿病视网膜病变 (DR) 是一个重要的公共卫生问题.
- 与社会经济地位和慢性疾病相关的健康结果的差异仍然存在.
研究的目的:
- 调查教育程度如何影响美国成年人死亡风险.
- 检查糖尿病和糖尿病视网膜病变 (DR) 的存在是否会改变教育和死亡率之间的关联.
- 量化糖尿病和DR对死亡率社会经济差异的影响.
主要方法:
- 来自1999-2018年国家健康和营养检查调查 (NHANES) 的全国代表性样本 (54,924名成年人) 的分析.
- 利用多变量Cox比例危险模型来评估教育程度 (低,中,高) 和全因死亡率之间的关联.
- 采用斜率不平等指数 (SII) 来评估教育阶层的生存率差异,按糖尿病和DR状态分层.
主要成果:
- 在所有糖尿病状态中,较低的教育程度始终与增加全因死亡风险有关.
- 与低教育相关的死亡风险在糖尿病患者中显著扩大,有或没有DR,与没有糖尿病的人相比.
- 斜率不平等指数表明,随着糖尿病的存在,生存率差距大幅扩大,与非糖尿病组相比大约翻了一番.
结论:
- 基于教育程度的死亡风险差异因糖尿病的存在而加剧,无论糖尿病视网膜病变 (DR).
- 这些发现强调了糖尿病预防在缓解与教育等社会经济因素相关的健康不平等方面发挥的关键作用.
- 解决糖尿病问题对于减少与社会经济地位相关的整体健康差异至关重要.
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