Low-income women at greater risk for diabetes than high-income women: study

TORONTO — Lower-income women were more likely to develop Type 2 diabetes than high-income women in a 14-year study, even when researchers controlled for the effects of being overweight and ethnic and cultural background.
The authors of the paper, released Wednesday by Statistics Canada, say it indicates something else may be at play, such as stress, psychological factors or diet.

“People in these lower socio-economic groups tend to also be more likely to be more physically inactive, to be obese or to be heavy smokers,” said co-author Heather Gilmour of the health analysis division at Statistics Canada.
“But the important thing about this study is that even when we controlled for that, there’s still something remaining about low income, for example, that is increasing the risk for diabetes among women.”
She said the data didn’t allow them to determine what this might be.
“For example, we don’t know whether the association could be related to stress or psychological factors ... and these things need further investigation to understand why low income is associated with diabetes incidence.”
The study is based on 12,333 respondents to the National Population Health Survey.
Among the people 18 and older who were free of diabetes in 1994-95 and tracked for almost a decade and a half, 7.2 per cent of men and 6.3 per cent of women had developed or died from the disease by 2008-09.
Another researcher, Nancy Ross, a professor in the department of geography at McGill University in Montreal, said that beyond what was controlled for in the study, something else remains that’s contributing to low socio-economic status being associated with greater risk of diabetes onset.
One element could relate to women having children, she theorized.
“For example, women at risk for gestational diabetes also fall into very low income categories, and that may then translate into onset of Type 2 diabetes later on in life,” Ross said.
Dr. Kaberi Dasgupta, also a co-author, said the findings highlight that there’s not just one aspect to being socially disadvantaged that can get someone into trouble.
She too theorized that the stress of daily living could play a role.
“We know that people who are more stressed and depressed are going to be less likely to look after themselves,” she said from Montreal, where she is a physician at McGill University Health Centre.
For instance, access to dental hygiene and dental care could differ by social class, and there’s some evidence that low-grade levels of inflammation and infection could stimulate blood-sugar levels, Dasgupta said.
“The idea is that it’s not just what people are doing or not doing in terms of healthy behaviours, but that whole sum total of the exposures that they have in being disadvantaged and maybe less able to protect themselves and their body from social and environmental stressors,” she said.
Michele Smith, a registered nurse and certified diabetes educator, noted that a person’s socio-economic status, if it’s low, will likely remain that way after diagnosis — and many of the working poor wouldn’t have insurance coverage for drugs and equipment.
It can cost $2 to $3 a day just to monitor glucose levels, she said, and some people have to take cholesterol agents, which can cost around $1 a day.
“They also usually should be placed on blood-pressure agents, and we know that most people’s blood pressure is not controlled simply by one pill. Some people need two or three pills,” she said from the diabetes outreach clinic in Eganville, Ont.
Dasgupta said people who have diabetes are at risk of developing heart disease or stroke, and ultimately there will be a cost to society and individuals.
“We acknowledge, luckily to some degree, obesity and physical inactivity, but at a conference or a large proceeding, I’ll rarely see poverty or low social class appear on that list of causal factors,” she said. “So I think it’s just something we have to consider in prevention and in management of patients with chronic disease.”
Michael Cloutier, president and CEO of the Canadian Diabetes Association, welcomed the Statistics Canada report.
“The report’s main findings really confirm the increased risk of diabetes for populations with low income and low education levels, coupled with new information concerning the greater vulnerability of women in developing Type 2 diabetes within these populations,” he said.
“This will certainly help to inform new targeted strategies to address the growing burden of diabetes in Canada.”
More than three million Canadians live with diabetes. About 90 per cent have Type 2 diabetes and 10 per cent have Type 1.