Associations between Educational Attainment and Diabetes in Utah: The Behavioral Risk Factor Surveillance System, 1996-2007

Background: Diabetes—now the sixth leading cause of death in Utah—has become more prevalent in recent decades. Diabetes is especially common among disadvantaged groups in Utah, such as persons without a high school diploma. To achieve stated public health goals of eliminating health disparities and increasing years of healthy life, steps must be taken to reverse recent trends in diabetes. Objectives: The main goal of this study is to examine how educational attainment is related to diabetes trends in the state of Utah over the period 1996-2007. Methods: We used Utah data from the Behavioral Risk Factor Surveillance System (BRFSS) to calculate the prevalence of diabetes by sex and educational attainment for three time periods (1996-1999, 2000-2003, and 2004-2007). To investigate how educational attainment and other possible determinants influence the odds of diabetes, we examined a series of logistic regression models that were stratified by sex. Results: The prevalence of diabetes among adults in Utah increased by 44% during the period of observation in this study (from 4.37% in 1996-1999 to 6.30% in 2004-2007). In models controlling for age and educational status, the odds of diabetes were 60% higher among men and 44% higher among women in 2004-2007 than in 1996-1999. These models also showed significant inverse associations between educational attainment and the odds of diabetes. For instance, women with a college education were 27% less likely than women with a high school education to have diabetes. However, interaction effects between educational attainment and period of observation were not statistically significant, indicating that these disparities have neither diminished nor widened from 1996-2007. Sociodemographic and health-related factors accounted for most of the observed differences in the odds of diabetes among different educational groups. Conclusion: The prevalence of diabetes is increasing in Utah. Well-educated men and women exhibit lower rates of diabetes than those with less education, but these disparities have not changed appreciably over the past decade. To reduce disparities in diabetes among different educational groups, policymakers and other public health stakeholders should take measures to reduce high school dropout rates, encourage labor force participation, ameliorate poverty, and promote healthy lifestyles that are associated with weight maintenance