Achieving Total And HDL Cholesterol Targets Is Associated With Socioeconomic Disadvantage In Older Diabetic Persons

BACKGROUND People over the age of 60 with diabetes are considered at high risk for developing cardiovascular disease (CVD). Elevated lipid levels and socioeconomic disadvantage are known risk factors for CVD. Diabetes guidelines exist for lipid targets in order to lower CVD risk. However, little is known about the effect of socioeconomic disadvantage on lipid profiles within these individuals. This study aims to investigate the association between socioeconomic disadvantage and total and HDL cholesterol levels among individuals with diabetes in the Illawarra and Shoalhaven areas of Australia. METHODS Sex, age, lipid fractions and BMI data were extracted from the Southern IML Research (SIMLR) database for diabetic persons (HbA1c ≥6.5%) aged 60 years and older presenting for pathology between 2010 and 2014. Individuals were also assigned to an Index of Relative Socioeconomic Disadvantage (IRSD) quintile using their residential address. Associations between IRSD and being within lipid targets (total cholesterol <4.0mmol/L and HDL cholesterol >=1.0mmol/L) for males and females were evaluated using logistic regression. RESULTS Data for 10,483 males and 8,632 females were analysed. Socioeconomic disadvantage was associated with greater odds of being within total cholesterol targets amongst females (OR = 1.03, 95% CI 1.11-1.19). Reduced socioeconomic disadvantage was associated with greater odds of being within HDL cholesterol targets amongst males (OR = 1.06, CI 1.03-1.10). CONCLUSION Our analysis demonstrates opposing gradients for associations between IRSD and achieving lipid targets among at-risk males and females. Future research with the SIMLR dataset will investigate neighbourhood correlates of cardiovascular risk for primary care planning. Keywords: Chronic disease management and prevention, Primary health care, Social determinants of health Key messages: 1. Socioeconomic disadvantage may influence the likelihood of being within lipid targets, for those with diabetes. 2. Access to healthcare and use of lipid-lowering therapy within IRSD areas may contribute to lipid targets being met. 2. It is important for individuals with diabetes to reduce their CVD risk by adhering to guidelines for lipid targets.

Kathryn Weston

University of Wollongong