Education achievement and type 2 diabetes—what mediates the relationship in older adults? Data from the ESTHER study: a population-based cohort study

Christopher J. Steele , Ben Schöttker , Adele H. Marshall , Anne Kouvonen , Mark G. O'Doherty , Ute Mons , Kai-Uwe Saum , Paolo Boffetta , Antonia Trichopoulou , Hermann Brenner , Frank Kee


Objective The study aims to identify the mediating factors of the relationship between education achievement and incident type 2 diabetes mellitus (T2DM) in older adults. Design Population-based cohort study. Setting Participants were recruited from the German federal state of Saarland. Participants Participants were excluded if they had prevalent T2DM or missing data on prevalent T2DM, missing or zero follow-up time for incident T2DM or were under 50 years of age. The total sample consisted of 7462 individuals aged 50–75 years (42.8% men, mean age 61.7 years) at baseline (2000–02). The median follow-up time was 8.0 years. Methods Cox proportional hazards regression was initially used to determine the direct association between education achievement and incident T2DM. Using the Baron and Kenny approach, we then investigated the associations between education achievement and incident T2DM with the potential mediators. The contribution of each of the putative mediating variables was then calculated. Results A clear socioeconomic gradient was observed with regard to T2DM incidence with the lowest educated individuals at a greater risk of developing the disease during the follow-up period: HR (95% CI) high education: 0.52 (0.34 to 0.80); medium education: 0.80 (0.66 to 0.96). Seven of the variables considered explained a proportion of the education–T2DM relationship (body mass index, alcohol consumption, hypertension, fasting triglycerides, high-density lipoprotein (HDL) cholesterol, physical activity and smoking status), where the contribution of the variables ranged from 1.0% to 17.7%. Overall, the mediators explained 31.7% of the relationship. Conclusion By identifying the possible mediating factors of the relationship between education achievement and incident T2DM in older adults, the results of this study can be used to assist with the development of public health strategies that aim to reduce socioeconomic inequalities in T2DM.
Author Christopher J. Steele
Christopher J. Steele,,
, Ben Schöttker
Ben Schöttker,,
, Adele H. Marshall
Adele H. Marshall,,
, Anne Kouvonen (Filia we Wrocławiu / II Wydział Psychologii we Wrocławiu)
Anne Kouvonen,,
- II Wydział Psychologii we Wrocławiu
, Mark G. O'Doherty
Mark G. O'Doherty,,
, Ute Mons
Ute Mons,,
, Kai-Uwe Saum
Kai-Uwe Saum,,
, Paolo Boffetta
Paolo Boffetta,,
, Antonia Trichopoulou
Antonia Trichopoulou,,
, Hermann Brenner
Hermann Brenner,,
et al.`
Journal seriesBMJ Open, ISSN 2044-6055, (A 35 pkt)
Issue year2017
Publication size in sheets0.5
ASJC Classification2700 General Medicine
Languageen angielski
27. Steele BMJ Open 2017_Kouvonen-Education.pdf 391.99 KB
Additional file
Oświadczenie_publ_Anne Kouvonen_5 tekstów.pdf 281.18 KB
Score (nominal)35
Score sourcejournalList
Publication indicators Scopus SNIP (Source Normalised Impact per Paper): 2016 = 1.252; WoS Impact Factor: 2017 = 2.413 (2) - 2017=2.801 (5)
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