Purpose To understand the effect of socioeconomic status (SES) on the risk of complications in type 1 diabetes (T1D), we explored the relationship between SES and major diabetes complications in a prospective, observational T1D cohort study. Methods Complete data were available for 317 T1D persons within 4 years of age 28 (ages 24–32) in the Pittsburgh Epidemiology of Diabetes Complications Study. Age 28 was selected to maximize income, education, and occupation potential, and minimize the effect of advanced diabetes complications on SES. Results The incidences over 1–20 years follow-up of end-stage renal disease (ESRD) and coronary artery disease (CAD) were 2–3 times higher for T1D individuals without, compared to those with a college degree (p<0.05 for both), while autonomic neuropathy (AN) incidence was significantly higher for low income and/or non-professional participants (p<0.05 for both). HbA1c was inversely associated only with income level. In sex- and diabetes duration-adjusted Cox models, lower education predicted ESRD (HR=2.9, 95% CI, 1.1–7.7) and CAD (HR=2.5, 1.3–4.9), whereas lower income predicted AN (HR=1.7, 1.0–2.9) and lower extremity arterial disease (HR=3.7, 1.1–11.9). Conclusions These associations, partially mediated by clinical risk factors, suggest that lower SES T1D individuals may have poorer self-management and, thus, more diabetes complications.

us-map.html ¶ A list of severe manifestations of monkeypox can be found at https://emergency. cdc.gov/han/2022/han00475.asp. ** During the study period and as of October 21, 2022, CDC was notified by state and local jurisdictions of five decedents whose death certificates included monkeypox as a cause of death or contributing factor, six decedents whose cause of death is still under active investigation, and one decedent in whom the death was not monkeypox-related. Additional monkeypox cases involving severe disease or death might not be included in this report if CDC has not yet been notified about the case or if the case occurred outside of the study period.

Purpose Socioeconomic status (SES) as a risk factor for mortality in type 1 diabetes (T1D) has not been adequately studied prospectively Methods Complete clinical and SES (income, education, occupation) data were available for 317 T1D participants in the Pittsburgh Epidemiology of Diabetes Complications Study within 4 years of age 28 (chosen to maximize income, education, and occupational potential, and to minimize the SES effect of advanced diabetes complications). Vital status was determined as of 1/1/2008. Results Over a median 16 years of follow-up, 34 (10.7%) deaths occurred (SMR=4.1, 95% CI, 2.7–5.5). SMRs did not differ from the general population for those in the highest education and income groups, whereas in those with low SES, SMRs were increased. Mortality rates were 3 times lower for individuals with versus without a college degree (p=0.004) and nearly 4 times lower for the highest versus lower income groups (p=0.04). In Cox models adjusting for diabetes duration and sex, education was the only SES measure predictive of mortality (HR=3.0, 1.2–7.8), but lost significance after adjusting for HbA1c, non-HDL cholesterol, hypertension, and microalbuminuria (HR=2.1, 0.8–5.6). Conclusions The strong association of education with mortality in T1D is partially mediated by better glycemic, lipid and blood pressure control.

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