PDF(Pubmed)
Abstract：
Diabetes disproportionately affects minorities and those with low socioeconomic status (SES) in the United States, and differences in behavioral lifestyles are largely responsible for the unequal distribution of diabetes among different groups.
With data of 9,969 participants collected in the 2007-2008 and 2009-2010 cycles of the US National Health and Nutrition Examination Survey (NHANES), this study examined several mediators and their mediating effects in the connection between SES and the risk of diabetes. The SES is assessed by the income-to-poverty ratio (IPR), education level, and employment status. For the mediation analysis, we used health-related behaviors as mediators (smoking, alcohol use, consumption of green vegetables and fruits, physical activity and sedentary time, health insurance, and healthcare). In this study, the structural equation model was utilized to evaluate the mediating effects of behavioral lifestyle as a mediator in the relationship between SES and diabetes.
A total of 9,969 participants were included in this study. We found a negative nonlinear association between IPR and diabetes risk (Poverall < 0.001; Pnon-linear = 0.46), which was independent of the majority of known or suspected risk factors and confounding variables (gender, age, race). Participants with lower SES had higher risk of diabetes compared with those with higher SES. In mediating analysis, we found alcohol intake (OR = 0.996), physical activity (OR = 0.993), health insurance (OR = 0.998), and healthcare (OR = 1.002) mediated the IPR-diabetes association. But in the relationship between education status and diabetes, the mediation effect of alcohol intake (OR = 0.995), physical activity (OR = 0.991), and health care (OR = 1.008) were obvious. Likewise, alcohol intake (OR = 0.996), fruit intake (OR = 0.998), and health care (OR = 0.975) were important mediators in the association between employment status and diabetes.
This study provides critical insights on the link between SES and diabetes. Our results highlight that poor health-related behaviors and limited access to healthcare are important pathways for increased diabetes risk related to those with low SES, particularly among Mexican Americans and males. They should be top priorities for agencies and healthcare providers to develop behavior-related interventions to reduce inequalities in diabetes risk.
With data of 9,969 participants collected in the 2007-2008 and 2009-2010 cycles of the US National Health and Nutrition Examination Survey (NHANES), this study examined several mediators and their mediating effects in the connection between SES and the risk of diabetes. The SES is assessed by the income-to-poverty ratio (IPR), education level, and employment status. For the mediation analysis, we used health-related behaviors as mediators (smoking, alcohol use, consumption of green vegetables and fruits, physical activity and sedentary time, health insurance, and healthcare). In this study, the structural equation model was utilized to evaluate the mediating effects of behavioral lifestyle as a mediator in the relationship between SES and diabetes.
A total of 9,969 participants were included in this study. We found a negative nonlinear association between IPR and diabetes risk (Poverall < 0.001; Pnon-linear = 0.46), which was independent of the majority of known or suspected risk factors and confounding variables (gender, age, race). Participants with lower SES had higher risk of diabetes compared with those with higher SES. In mediating analysis, we found alcohol intake (OR = 0.996), physical activity (OR = 0.993), health insurance (OR = 0.998), and healthcare (OR = 1.002) mediated the IPR-diabetes association. But in the relationship between education status and diabetes, the mediation effect of alcohol intake (OR = 0.995), physical activity (OR = 0.991), and health care (OR = 1.008) were obvious. Likewise, alcohol intake (OR = 0.996), fruit intake (OR = 0.998), and health care (OR = 0.975) were important mediators in the association between employment status and diabetes.
This study provides critical insights on the link between SES and diabetes. Our results highlight that poor health-related behaviors and limited access to healthcare are important pathways for increased diabetes risk related to those with low SES, particularly among Mexican Americans and males. They should be top priorities for agencies and healthcare providers to develop behavior-related interventions to reduce inequalities in diabetes risk.
摘要：
■糖尿病不成比例地影响美国的少数民族和社会经济地位（SES）低的人，行为生活方式的差异在很大程度上是糖尿病在不同人群中分布不均的原因。
■根据美国国家健康与营养调查（NHANES）的2007-2008和2009-2010周期中收集的9,969名参与者的数据，本研究检测了几种介质及其在SES与糖尿病风险之间的中介作用.SES是通过收入与贫困比率(IPR)来评估的，教育水平,和就业状况。对于调解分析，我们使用与健康相关的行为作为中介(吸烟，酒精使用,食用绿色蔬菜和水果，身体活动和久坐时间，健康保险,和医疗保健）。在这项研究中,利用结构方程模型评估行为生活方式在SES与糖尿病关系中的中介作用.
■本研究共纳入9,969名参与者。我们发现IPR和糖尿病风险之间存在负的非线性关联（总体<0.001；Pnon-linear=0.46），这与大多数已知或可疑的危险因素和混杂变量(性别，年龄,种族)。与SES较高的参与者相比，SES较低的参与者患糖尿病的风险更高。在中介分析中，我们发现酒精摄入量(OR=0.996)，身体活动（OR=0.993），健康保险（OR=0.998），和医疗保健（OR=1.002）介导了IPR-糖尿病的关联。但在教育状况与糖尿病的关系中,酒精摄入的中介效应(OR=0.995)，身体活动（OR=0.991），和医疗保健（OR=1.008）明显。同样，酒精摄入量（OR=0.996），水果摄入量（OR=0.998），和医疗保健(OR=0.975)是就业状况与糖尿病之间的重要中介。
■这项研究提供了有关SES与糖尿病之间联系的重要见解。我们的研究结果突出表明，不良的健康相关行为和有限的医疗保健是与低SES患者相关的糖尿病风险增加的重要途径。尤其是墨西哥裔美国人和男性。它们应该是机构和医疗保健提供者制定行为相关干预措施以减少糖尿病风险不平等的首要任务。
■根据美国国家健康与营养调查（NHANES）的2007-2008和2009-2010周期中收集的9,969名参与者的数据，本研究检测了几种介质及其在SES与糖尿病风险之间的中介作用.SES是通过收入与贫困比率(IPR)来评估的，教育水平,和就业状况。对于调解分析，我们使用与健康相关的行为作为中介(吸烟，酒精使用,食用绿色蔬菜和水果，身体活动和久坐时间，健康保险,和医疗保健）。在这项研究中,利用结构方程模型评估行为生活方式在SES与糖尿病关系中的中介作用.
■本研究共纳入9,969名参与者。我们发现IPR和糖尿病风险之间存在负的非线性关联（总体<0.001；Pnon-linear=0.46），这与大多数已知或可疑的危险因素和混杂变量(性别，年龄,种族)。与SES较高的参与者相比，SES较低的参与者患糖尿病的风险更高。在中介分析中，我们发现酒精摄入量(OR=0.996)，身体活动（OR=0.993），健康保险（OR=0.998），和医疗保健（OR=1.002）介导了IPR-糖尿病的关联。但在教育状况与糖尿病的关系中,酒精摄入的中介效应(OR=0.995)，身体活动（OR=0.991），和医疗保健（OR=1.008）明显。同样，酒精摄入量（OR=0.996），水果摄入量（OR=0.998），和医疗保健(OR=0.975)是就业状况与糖尿病之间的重要中介。
■这项研究提供了有关SES与糖尿病之间联系的重要见解。我们的研究结果突出表明，不良的健康相关行为和有限的医疗保健是与低SES患者相关的糖尿病风险增加的重要途径。尤其是墨西哥裔美国人和男性。它们应该是机构和医疗保健提供者制定行为相关干预措施以减少糖尿病风险不平等的首要任务。
