SOCIAL DEPRIVATION AND MORTALITY IN ADULTS WITH DIABETES-MELLITUS

To investigate the relationship between measures of social deprivation and mortality in adults with diabetes, data from 2104 randomly select ed adults (>16 years of age) with Type 1 and Type 2 diabetes mellitus from 8 hospital out-patient departments were analysed. A total of 38% of subjects had Type 1 (diagnosed before the age of 36 years and treat ed with insulin), 55% were male and 85% Caucasian. During a follow-up period (mean (SD) of 8.4 (0.9) years), 293 (14%) of the subjects died, the most commonly recorded cause of death being cardiovascular diseas e. Duration adjusted odds ratios (OR) and 95% confidence intervals (CI ) were calculated separately for Type 1 and Type 2 subjects. The morta lity rates for men were higher than for women (Type 1: OR 1.27, CI 0.6 1-2.62; Type 2: OR 1.79, CI 1.27-2.52); were higher for those of lower vs higher social class (Type 1: OR 1.34, CI 0.61-2.96; Type 2: OR 2.0 , CI 1.41-2.85); and were higher for those who left school before 16 y ears of age compared to those who left school at or after 16 years of age (Type 1: OR 3.98, CI 1.96-8.06; Type 2: OR 2.86, CI 1.93-4.25). Su bjects who were unemployed had a higher mortality rate than those empl oyed at the time of the study (Type 1: OR 3.10, CI 1.67-5.79; Type 2: OR 2.88, CI 2.12-3.91) and those living in council housing had a great er mortality than those who were living in other types of housing (Typ e 1: OR 2.57, CI 1.35-4.91, Type 2: OR 2.76, CI 2.05-3.73). Also for b oth Type 1 and Type 2 subjects mortality was significantly higher in t hose subjects who had a least one diabetic complication at baseline an d reported one or more hospital admissions in the previous year and in Type 2 subjects with poor glycaemic control. After adjusting for dura tion of diabetes, hospital admissions, and the presence of diabetic co mplications, being unemployed, male, in poor glycaemic control (Type 2 only), and less educated were significant risk factors for mortality (p<0.001). These results suggest that there are important indicators o f social deprivation which predict mortality over and above diabetic h ealth status itself. Locally targeted action will be required if these inequalities in health experienced by people with diabetes are to be reduced. (C) 1998 John Wiley & Sons, Ltd.