1658-P: Socioeconomic Position and All-Cause Mortality among Adults with Diagnosed Diabetes across Racial/Ethnic Groups—United States, 1997-2011

Among all adults with diagnosed diabetes (DM), the rate of all-cause mortality is inversely associated with socioeconomic position (SEP). However, the social patterning among adults of different racial/ethnic origin is less clear. We examined changes in 5-year all-cause mortality rates in U.S. adults with diagnosed DM across racial/ethnic groups [non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic] by SEP [education and income to poverty ratio (IPR)]. Using data on 32,986 participants aged ≥25 years with DM from the National Health Interview Survey during 1997-2011, we calculated race/ethnicity stratified mortality rates and changes in rates using predictive margins from Poisson regression adjusted for age. From 1997-2001 to 2007-2011 in adults with education of <high school, mortality rates decreased in NHW [from 30.4 to 24.6 deaths/1000 person-years: change = -5.8 (95% confidence interval: -10.4, -1.2)], NHB [21.7 to 16.8: -4.9 (-9.5, -0.4)], and Hispanics [16.7 to 11.4: -5.3 (-9.7, -1.0)]. In those with a high school education, although mortality rates did not change significantly in NHB and Hispanics, there was a decrease in mortality rate in NHW [25.9 to 21.4: -4.5(-8.2, -0.7)]. No significant changes were observed in those with >high school education during this time. When considering changes related to IPR, there were significant decreases in mortality rates in NHW adults with IPR between 200-399% [26.0 to 20.4: -5.7 (-10.1, -1.2)] and ≥ 400% [23.1 to 15.4: -7.7 (-12.5, -2.9)] but no significant changes for IPR of <100% and 100-199%. In contrast, there was a decrease in mortality rates for IPR <100% in NHB [28.7 to 17.5: -11.2 (-19.6, -2.8)] and Hispanics [16.3 to 10.2: -6.1 (-11.4, -0.7)] but no significant changes for IPRs of 100-199%, 200-399%, or ≥ 400% in these groups. Improvements in mortality rates in U.S. adults with DM by educational attainment were similar across racial/ethnic groups but varied when considering IPR for SEP.