Abstract
Objectives: Low socioeconomic position (SEP) and Type 2 diabetes are cardiovascular disease (CVD) risk factors; however, whether they interact to increase CVD risk further is unknown. SEP, diabetes and CVD vary across ethnic groups; it is important to understand how these relationships differ across groups. Methods: Longitudinal data were collected from 2,028 White European and 1,475 South Asian adults from a community based cohort study in northwest London. At baseline (1989), manual occupation defined low SEP and Type 2 diabetes was determined based on participant/GP record. Fatal/non-fatal CVD events were assessed at 20-year follow-up using participant/GP/hospital records. Results: Of those with diabetes, 61% of low and 62% of high SEP Europeans and 75% of low and 56% of high SEP South Asians had experienced a CVD event by follow-up. Among South Asians, in age-, sex- and baseline CVD-adjusted Cox regression models, there was a significant diabetes–SEP interaction (p=0.021); low SEP South Asians with diabetes had nearly double the CVD risk of their high SEP counterparts [hazard ratio (HR) 1.80, 95% confidence interval 1.15–2.82) (in South Asians without diabetes, SEP was not associated with CVD, HR 1.05, 0.86–1.28). In contrast, in Europeans, the risk of CVD did not differ between high and low SEP individuals, with or without diabetes (HR 1.15, 0.58–2.27 and HR 1.17, 0.99–1.39, respectively). Conclusions: This study demonstrates that the combination of diabetes and socioeconomic disadvantage is associated with higher CVD risk in South Asian people. Among South Asians with Type 2 diabetes, socioeconomic adversity may be important in the identification of individuals at increased risk of CVD.