PMID- 28420660
OWN - NLM
STAT- MEDLINE
DCOM- 20171220
LR  - 20190202
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 7
IP  - 4
DP  - 2017 Apr 17
TI  - Education achievement and type 2 diabetes-what mediates the relationship in older 
      adults? Data from the ESTHER study: a population-based cohort study.
PG  - e013569
LID - 10.1136/bmjopen-2016-013569 [doi]
LID - e013569
AB  - 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.
CI  - (c) Article author(s) (or their employer(s) unless otherwise stated in the text of 
      the article) 2017. All rights reserved. No commercial use is permitted unless 
      otherwise expressly granted.
FAU - Steele, Christopher J
AU  - Steele CJ
AD  - UKCRC Centre of Excellence for Public Health, Queen's University Belfast, 
      Belfast, UK csteele09@qub.ac.uk.
AD  - Centre for Statistical Science and Operational Research (CenSSOR), Queen's 
      University Belfast, Belfast, UK.
FAU - Schottker, Ben
AU  - Schottker B
AD  - German Cancer Research Center (DKFZ), Heidelberg, Germany.
AD  - Institute of Health Care and Social Sciences, FOM Hochschule, Essen, Germany.
FAU - Marshall, Adele H
AU  - Marshall AH
AD  - UKCRC Centre of Excellence for Public Health, Queen's University Belfast, 
      Belfast, UK.
AD  - Centre for Statistical Science and Operational Research (CenSSOR), Queen's 
      University Belfast, Belfast, UK.
FAU - Kouvonen, Anne
AU  - Kouvonen A
AD  - Social Research, University of Helsinki, Helsinki, Finland.
AD  - Faculty in Wroclaw, SWPS University of Social Sciences and Humanities, Wroclaw, 
      Poland.
FAU - O'Doherty, Mark G
AU  - O'Doherty MG
AD  - UKCRC Centre of Excellence for Public Health, Queen's University Belfast, 
      Belfast, UK.
FAU - Mons, Ute
AU  - Mons U
AD  - German Cancer Research Center (DKFZ), Heidelberg, Germany.
FAU - Saum, Kai-Uwe
AU  - Saum KU
AD  - German Cancer Research Center (DKFZ), Heidelberg, Germany.
FAU - Boffetta, Paolo
AU  - Boffetta P
AD  - The Tisch Cancer Institute and Institute for Translational Epidemiology, Icahn 
      School of Medicine at Mount Sinai, New York, New York, USA.
AD  - Hellenic Health Foundation, Athens, Greece.
FAU - Trichopoulou, Antonia
AU  - Trichopoulou A
AD  - Hellenic Health Foundation, Athens, Greece.
AD  - Department of Hygiene and Epidemiology, University of Athens, Medical School, 
      Athens, Greece.
FAU - Brenner, Hermann
AU  - Brenner H
AD  - German Cancer Research Center (DKFZ), Heidelberg, Germany.
AD  - Network Aging Research, University of Heidelberg, Heidelberg, Germany.
FAU - Kee, Frank
AU  - Kee F
AD  - UKCRC Centre of Excellence for Public Health, Queen's University Belfast, 
      Belfast, UK.
LA  - eng
PT  - Journal Article
DEP - 20170417
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
RN  - 0 (Cholesterol, HDL)
RN  - 0 (Triglycerides)
SB  - IM
MH  - Aged
MH  - Alcohol Drinking/*epidemiology
MH  - Body Mass Index
MH  - Cholesterol, HDL/blood
MH  - Cohort Studies
MH  - Diabetes Mellitus, Type 2/*epidemiology
MH  - Dyslipidemias/blood/*epidemiology
MH  - *Educational Status
MH  - *Exercise
MH  - Female
MH  - Germany/epidemiology
MH  - Humans
MH  - Hypertension/*epidemiology
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Proportional Hazards Models
MH  - Smoking/*epidemiology
MH  - Social Class
MH  - Triglycerides/blood
PMC - PMC5719655
OTO - NOTNLM
OT  - Type 2 diabetes mellitus
OT  - mediation
OT  - older adults
OT  - socioeconomic position
COIS- Competing interestsNone declared.
EDAT- 2017/04/20 06:00
MHDA- 2017/12/21 06:00
PMCR- 2017/04/17
CRDT- 2017/04/20 06:00
PHST- 2017/04/20 06:00 [entrez]
PHST- 2017/04/20 06:00 [pubmed]
PHST- 2017/12/21 06:00 [medline]
PHST- 2017/04/17 00:00 [pmc-release]
AID - bmjopen-2016-013569 [pii]
AID - 10.1136/bmjopen-2016-013569 [doi]
PST - epublish
SO  - BMJ Open. 2017 Apr 17;7(4):e013569. doi: 10.1136/bmjopen-2016-013569.