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 to minimize the effect of advanced diabetes complications on SES.
The incidences over 1 to 20 years’ follow-up of end-stage renal disease and coronary artery disease were two to three times greater for T1D individuals without, compared with those with a college degree (p < .05 for both), whereas the incidence of autonomic neuropathy was significantly greater for low-income and/or nonprofessional participants (p < .05 for both). HbA1c was inversely associated only with income level. In sex- and diabetes duration-adjusted Cox models, lower education predicted end-stage renal disease (hazard ratio [HR], 2.9; 95 % confidence interval [95 % CI], 1.1−7.7) and coronary artery disease (HR, 2.5, 95 % CI, 1.3−4.9), whereas lower income predicted autonomic neuropathy (HR, 1.7; 95 % CI, 1.0−2.9) and lower-extremity arterial disease (HR, 3.7; 95 % CI, 1.1−11.9).
These associations, partially mediated by clinical risk factors, suggest that lower SES T1D individuals may have poorer self-management and, thus, greater complications from diabetes.