标题：Childhood Socioeconomic Position, Gender, Adult Body Mass Index, and Incidence of Type 2 Diabetes Mellitus Over 34 Years in the Alameda County Study
摘要：Objectives. We examined the association between childhood socioeconomic position and incidence of type 2 diabetes and the effects of gender and adult body mass index (BMI). Methods. We studied 5913 participants in the Alameda County Study from 1965 to 1999 who were diabetes free at baseline (1965). Cox proportional hazards models estimated diabetes risk associated with childhood socioeconomic position and combined childhood socioeconomic position–adult BMI categories in pooled and gender-stratified samples. Demographic confounders and potential pathway components (physical inactivity, smoking, alcohol consumption, hypertension, depression, health care access) were included as covariates. Results. Low childhood socioeconomic position was associated with excess diabetes risk, especially among women. Race and body composition accounted for some of this excess risk. The association between childhood socioeconomic position and diabetes incidence differed by adult BMI category in the pooled and women-only groups. Adjustment for race and behaviors attenuated the risk attributable to low childhood socioeconomic position among the obese group only. Conclusions. Childhood socioeconomic position was a robust predictor of incident diabetes, especially among women. A cumulative risk effect was observed for both childhood socioeconomic position and adult BMI, especially among women. In recent years, much effort has gone into characterizing biological and social exposures during gestation and childhood that may lead to adult chronic diseases. Childhood socioeconomic disadvantage has been associated with mortality 1 – 4 and several adult physical 5 – 7 and mental health 5 , 7 – 9 outcomes. Studies investigating the relationship between childhood socioeconomic disadvantage and diabetes have shown inconsistent results. Childhood socioeconomic position (SEP) was linked to prevalent type 2 diabetes, 10 – 14 insulin resistance, 15 higher glucose levels, 16 , 17 and metabolic syndrome 18 , 19 in some studies, yet showed no association with impaired glucose tolerance 20 , 21 or metabolic syndrome 22 in others. Three studies investigated the association between childhood SEP and incident diabetes in adulthood and reported either modest 11 , 23 or no effects. 12 Although the evidence thus far is insufficient to establish a causal link between childhood SEP and incident type 2 diabetes, the hypothesis is plausible. Childhood disadvantage has been linked to illnesses, such as cardiovascular diseases, 24 that have overlapping pathologies with diabetes. Persons exposed to socioeconomic disadvantage in childhood are more likely to be of lower socioeconomic means as adults. 25 , 26 Several studies have shown inverse, graded associations between different measures of adult SEP and the prevalence 11 , 13 , 22 , 27 , 28 and incidence 11 , 12 , 23 , 29 – 34 of type 2 diabetes. Childhood SEP also influences adult body composition 35 – 41 and several behaviors 20 , 42 – 45 that are risk factors for type 2 diabetes. Obesity is a strong predictor of type 2 diabetes. 46 – 48 Therefore, the effect of childhood SEP on diabetes incidence may differ by body mass index (BMI; weight in kilograms divided my height in meters squared) in adulthood. For example, low childhood SEP and adult obesity together may impart a greater risk of type 2 diabetes than the risk imparted by low childhood SEP alone. Such exposure patterns may represent an accumulation of risk over time or a risk pathway. In addition, several studies have shown that the effects of childhood circumstances on adult health and risk behaviors differ by gender. 37 , 38 , 40 , 49 – 52 The question remains whether childhood SEP differentially influences diabetes risk for women and men. Previous studies of childhood SEP and incident diabetes had short follow-up periods, 11 , 12 , 23 and one was limited to women. 23 Our approach complemented these studies by using 5 waves of data collected in a population-based sample from 1965 to 1999 to examine the association between childhood SEP and the incidence of type 2 diabetes and how this association may differ by gender or adult BMI.
