Jackson Heart Study: Socioeconomic Influences on Diabetes
By Stephanie Gandy
Lower socioeconomic status contributes to diabetes prevalence in African-Americans, a new paper from the Jackson Heart Study found, but researchers noted differences in men and women's awareness, treatment and control of the disease.
Using data from 4,330 African-Americans in the Jackson-metro area, researchers analyzed the association between socioeconomic status, defined by education, income and occupation, on diabetes prevalence, awareness, treatment and control. To ensure accuracy in the data, the study's authors accounted for other diabetes risk factors.
"This study means we did find a social gradient in diabetes prevalence," said Dr. Mario Sims, associate professor of medicine and lead author on the paper. "The lower status you are, the higher your prevalence of diabetes."
Sims and his coauthors found that low-income men and women had a greater probability of diabetes than their high-income counterparts. They also found that poorly educated people in low-status jobs had a higher prevalence of diabetes than highly educated people in management jobs, but only among men. The journal Annals of Epidemiology published the paper in its July issue.
What caught the researchers by surprise was that women showed a greater awareness of their disease, sought treatment more regularly and exhibited better control of their hemoglobin A1c levels. Sims said he expected the men and women to be similar. Many factors likely contribute to this gender disparity.
"This (disparity) tells us that we can't make blanket statements about populations," Sims said. "This is just a lesson of the heterogeneity of our sample. Women behave differently than men do or higher-status people behave differently than lower-status people do. The heterogeneity of our sample is key."
In both men and women, diabetes control measured significantly lower than their awareness and treatment levels. Sims explained that participants were asked whether they sought treatment, but they measured people's control of diabetes by analyzing hemoglobin A1c levels.
If a person's A1c levels fall below 7 percent, their diabetes is not controlled, said Sims. Overall, control was low for the sample, suggesting that high socioeconomic status and access to care do not protect the sample's African-Americans from uncontrolled diabetes.
Furthermore, the researchers found awareness and treatment were patterned by socioeconomic status in women, but not in men.
Linking socioeconomic status to diabetes can help researchers understand the external factors affecting African-Americans' health. This research may also help physicians understand the disease in a new way and help develop culturally competent approaches to care that reduce the disparities in diabetes rates.
"In order to introduce diabetes prevention and intervention, we need to look at what places lower-status African-Americans at a greater risk for diabetes," Sims said.
Information from the participants used in the paper was gathered from the Jackson Heart Study. The JHS is a 10-year-old population study of cardiovascular disease in African-Americans. It is a collaboration between UMMC, Jackson State University and Tougaloo College.
Funding for Sims' study came through an Early Career Development K01 Award from the National Heart, Lung and Blood Institute and the National Center for Minority Health and Health Disparities.