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Siobhan C. Maty, PhD, MPH, Sherman A. James, PhD and George A. Kaplan, PhD

Siobhan C. Maty is with the School of Community Health, Portland State University, Portland, OR. Sherman A. James is with the Terry Sanford Institute for Public Policy, Duke University, Durham, NC. George A. Kaplan is with the Department of Epidemiology and the Center for Social Epidemiology and Population Health, School of Public Health, University of Michigan, Ann Arbor.

Correspondence: Requests for reprints should be sent to Siobhan C. Maty, PhD, MPH, Assistant Professor, School of Community Health, Portland State University, PO Box 751, Portland, OR 97207-0751 (e-mail: maty{at}pdx.edu).

Objectives. We examined associations between several life-course socioeconomic position (SEP) measures (childhood SEP, education, income, occupation) and diabetes incidence from 1965 to 1999 in a sample of 5422 diabetes-free Black and White participants in the Alameda County Study.

Methods. Race-specific Cox proportional hazard models estimated diabetes risk associated with each SEP measure. Demographic confounders (age, gender, marital status) and potential pathway components (physical inactivity, body composition, smoking, alcohol consumption, hypertension, depression, access to health care) were included as covariates.

Results. Diabetes incidence was twice as high for Blacks as for Whites. Diabetes risk factors independently increased risk, but effect sizes were greater among Whites. Low childhood SEP elevated risk for both racial groups. Protective effects were suggested for low education and blue-collar occupation among Blacks, but these factors increased risk for Whites. Income was protective for Whites but not Blacks. Covariate adjustment had negligible effects on associations between each SEP measure and diabetes incidence for both racial groups.

Conclusions. These findings suggest an important role for life-course SEP measures in determining risk of diabetes, regardless of race and after adjustment for factors that may confound or mediate these associations.

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