Is hemoglobin A1c level associated with measures of socio-economic status in non-diabetics after controlling for known explanatory factors?



Objective: Glycosylated hemoglobin (GHb) is a well-validated measure of control in diabetics but fasting glucose levels account for only a portion of the variance in non-diabetics. Stress has been suggested as a factor driving socio-economic inequalities in health and GHb appears to be elevated in stressed populations. This project examined the relationship between GHb levels and measures of socio-economic status (SES) in non-diabetics.

Methods: Data were used from 1828 individuals in the National Health and Nutrition Examination Survey (NHANES) 1999–2000 dataset with fasting glucose samples and GHb levels (HbA1c) <7.5 per cent. The effect of adding individual measures of SES to the models after controlling for explanatory factors was assessed.

Results: Associations were found, in non-diabetics, between HbA1c levels and measures of SES after controlling for fasting glucose level, age and weekly alcohol consumption in both men and women. For men, serum insulin also contributed to the models.

Conclusion: SES was found to have graded relationships with HbA1c and relatively small or non-existent associations with other metabolic syndrome factors. HbA1c levels were significantly associated with three measures of social status in women and four measures in men. Copyright © 2005 John Wiley & Sons, Ltd.