Life Course Socioeconomic Position, Allostatic Load, and Incidence of Type 2 Diabetes among African America n Adults: The Jackson Heart Study, 2000-04 to 2012

Abstract

Objective: We examined whether life course socioeconomic position (SEP) was associated with incidence of type 2 diabetes (t2DM) among African Americans.Design: Secondary analysis of data from the Jackson Heart Study, 2000-04 to 2012, using Cox proportional hazard regression to estimate hazard ratios (HR) with 95% CI for t2DM incidence by measures of life course SEP.Participants: Sample of 4,012 nondiabetic adults aged 25-84 years at baseline.Outcome Measure: Incident t2DM identi­fied by self-report, hemoglobin A1c ≥6.5%, fasting plasma glucose ≥126 mg/dL, or use of diabetes medication.Results: During 7.9 years of follow-up, 486 participants developed t2DM (incidence rate 15.2/1000 person-years, 95% CI: 13.9-16.6). Among women, but not men, childhood SEP was inversely associated with t2DM incidence (HR=.97, 95% CI: .94-.99) but was no longer associated with adjust­ment for adult SEP or t2DM risk factors. Up­ward SEP mobility increased the hazard for t2DM incidence (adjusted HR=1.52, 95% CI: 1.05-2.21) among women only. Life course allostatic load (AL) did not explain the SEP-t2DM association in either sex.Conclusions: Childhood SEP and up­ward social mobility may influence t2DM incidence in African American women but not in men.Ethn Dis. 2019;29(1):39-46; doi:10.18865/ed.29.1.39