Socioeconomic and behavioural risk factors for mortality of individuals with IDDM in Japan: population-based case-control study

Abstract

The aim of this population-based, one-to-one matched-pair case-control study was to evaluate the factors concerning the markedly increased risk for dying among Japanese subjects with insulin-dependent diabetes mellitus (IDDM) from a social and behavioural perspective. The study was based on the population-based cohort of IDDM subjects in the Diabetes Epidemiology Research International Mortality Study. We studied 90 cases who died and 90 living control subjects, selected from the rest of the cohort, who were matched for sex, birth year, year of diagnosis and duration of diabetes. Socioeconomic and behavioural status were surveyed through a questionnaire. Conditional logistic regression analyses based on 55 respondent pairs revealed that the better educated patients (year of completing education: odds ratio = 0.66) who kept the same physician (number of times a patient changed physician: odds ratio = 2.77) and who attended a clinic specializing in diabetes (attendance at university hospital clinic: odds ratio = 0.18) injecting insulin several times a day (number of injections, odds ratio = 0.31) and more frequently attending the clinic (> or = 12 times per year, odds ratio = 0.23) were at substantially lower risk of death. The results begin to profile the patients with the highest risk of dying who could be identified earlier and undergo intervention treatment.

Socioeconomic differences in mortality among diabetic people in Finland: five year follow up

“…In line with these findings, it has been shown that in Finland survival from cancer17 and heart disease18 is best in the higher social classes. Furthermore, earlier studies in the United States19 and Japan20 have suggested that mortality of people with insulin dependent diabetes is highest in those with a low socioeconomic position.…”

Socioeconomic gradient in morbidity and mortality in people with diabetes: cohort study findings from the Whitehall study and the WHO multinational study of vascular disease in diabetes

“…Risk factors which may account for a socioeconomic gradient in mortality risk were not measured in the Finnish study, and their counterintuitive findings cannot be explored further. Few other studies have examined the socioeconomic gradient in mortality in diabetic people,6 7 8 and none has included a non-diabetic population for comparison.…”