You have full access to this open access article. China has undergone rapid socioeconomic transition accompanied by lifestyle changes that are expected to have a profound impact on the health of its population. However, there is limited evidence from large nationwide studies about the relevance of socioeconomic status SES to risk of diabetes. We describe the associations of two key measures of SES with prevalent and incident diabetes in Chinese men and women.
The China Kadoorie Biobank study included 0. SES was assessed using the highest educational level attained and annual household income. Prevalent diabetes was identified from self-report and plasma glucose measurements. Incident diabetes was identified from linkage to disease and death registries and national health insurance claim databases. At baseline, 30, 5. There were , people without prevalent diabetes at baseline, of whom 2. For household income, the adjusted ORs for prevalent diabetes, comparing highest vs lowest categories, were 1.
Among Chinese adults, the associations between education and diabetes prevalence and incidence differed qualitatively between men and women, whereas higher household income was positively associated with diabetes prevalence and incidence in both sexes, with a stronger relationship in men than in women. The prevalence of diabetes in China has increased markedly in the past few decades.
The proportion of Chinese adults estimated to have diabetes was 0. Evidence from developed countries that have completed the epidemiological transition shows that non-communicable diseases NCDs are initially more common in population subgroups of high socioeconomic status SES and then, with increasing development, become more common in lower SES groups [ 5 ]. However, the evidence from low- and middle-income countries LMIC is limited [ 6 ].
Previous studies have reported inconsistent associations between SES and diabetes prevalence in mainland China, and findings were not obviously influenced by study year or the level of economic development of the study area [ 7 , 8 ]. However, in Hong Kong and Taiwan, where economic development and epidemiological transition are at a more advanced stage than in mainland China, an inverse association between SES and diabetes prevalence has been described [ 7 ]. Reliable assessment of the association between SES and diabetes in different parts of China is needed to plan and evaluate health services and diabetes prevention strategies.
