Abstract
OBJECTIVE: We examined disparities in diabetes-related mortality for socioeconomic status (SES) groups in nationally representative U.S. samples. METHODS: We analyzed National Health Interview Survey respondents linked to their death records and included those eligible for mortality follow-up who were aged 25 years and older at the time of interview and not missing information on covariates (n=527,426). We measured SES by education and family income. There were 5,613 diabetes-related deaths. RESULTS: Having less than a high school education was associated with a twofold higher mortality from diabetes, after controlling for age, gender, race/ethnicity, marital status, and body mass index, compared with adults with a college degree or higher education level (relative hazard [RH] = 2.05, 95% confidence interval [CI] 1.78, 2.35). Having a family income below poverty level was associated with a twofold higher mortality after adjustments compared with adults with the highest family incomes (RH=2.41, 95% CI 2.05, 2.84). Approximately one-quarter of the excess risk among those in the lowest SES categories was explained by adjusting for potential confounders. CONCLUSION: Findings from this nationally representative cohort demonstrate a socioeconomic gradient in diabetes-related mortality, with both education and income being important determinants of the risk of death.