Obesity mediates the opposite association of education and diabetes in Chinese men and women: Results from the REACTION study

Yuanyue Zhu; Chunyan Hu; Lin Lin; Shuangyuan Wang; Hong Lin; Yanan Huo; Qin Wan; Yingfen Qin; Ruying Hu; Lixin Shi; Qing Su; Xuefeng Yu; Li Yan; Guijun Qin; Xulei Tang; Gang Chen; Min Xu; Yu Xu; Tiange Wang; Zhiyun Zhao; Zhengnan Gao; Guixia Wang; Feixia Shen; Zuojie Luo; Li Chen; Qiang Li; Zhen Ye; Yinfei Zhang; Chao Liu; Youmin Wang; Shengli Wu; Tao Yang; Huacong Deng; Lulu Chen; Tianshu Zeng; Jiajun Zhao; Yiming Mu; Weiqing Wang; Guang Ning; Yufang Bi; Yuhong Chen; Jieli Lu

doi:10.1111/1753-0407.13325

Obesity mediates the opposite association of education and diabetes in Chinese men and women: Results from the REACTION study

J Diabetes. 2022 Nov;14(11):739-748. doi: 10.1111/1753-0407.13325. Epub 2022 Oct 11.

Authors

Yuanyue Zhu^#^{1

2}, Chunyan Hu^#^{1

2}, Lin Lin^#^{1

2}, Shuangyuan Wang^{1

2}, Hong Lin^{1

2}, Yanan Huo³, Qin Wan⁴, Yingfen Qin⁵, Ruying Hu⁶, Lixin Shi⁷, Qing Su⁸, Xuefeng Yu⁹, Li Yan¹⁰, Guijun Qin¹¹, Xulei Tang¹², Gang Chen¹³, Min Xu^{1

2}, Yu Xu^{1

2}, Tiange Wang^{1

2}, Zhiyun Zhao^{1

2}, Zhengnan Gao¹⁴, Guixia Wang¹⁵, Feixia Shen¹⁶, Zuojie Luo⁵, Li Chen¹⁷, Qiang Li¹⁸, Zhen Ye⁶, Yinfei Zhang¹⁹, Chao Liu²⁰, Youmin Wang²¹, Shengli Wu²², Tao Yang²³, Huacong Deng²⁴, Lulu Chen²⁵, Tianshu Zeng²⁵, Jiajun Zhao²⁶, Yiming Mu²⁷, Weiqing Wang^{1

2}, Guang Ning^{1

2}, Yufang Bi^{1

2}, Yuhong Chen^{1

2}, Jieli Lu^{1

2}

Affiliations

¹ Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³ Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China.
⁴ The Affiliated Hospital of Luzhou Medical College, Luzhou, China.
⁵ The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
⁶ Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
⁷ Affiliated Hospital of Guiyang Medical University, Guiyang, China.
⁸ Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁹ Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹⁰ Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
¹¹ The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
¹² The First Hospital of Lanzhou University, Lanzhou, China.
¹³ Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.
¹⁴ Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian, China.
¹⁵ The First Hospital of Jilin University, Changchun, China.
¹⁶ The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
¹⁷ Qilu Hospital of Shandong University, Jinan, China.
¹⁸ The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
¹⁹ Central Hospital of Shanghai Jiading District, Shanghai, China.
²⁰ Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China.
²¹ The First Affiliated Hospital of Anhui Medical University, Hefei, China.
²² Karamay Municipal People's Hospital, Xinjiang, China.
²³ The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
²⁴ The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
²⁵ Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
²⁶ Shandong Provincial Hospital affiliated to Shandong University, Jinan, China.
²⁷ Chinese People's Liberation Army General Hospital, Beijing, China.

^# Contributed equally.

Abstract
in English, Chinese

Background: Evidence regarding the impact of education on diabetes risk is scarce in developing countries. We aimed to explore the association between education and diabetes within a large population in China and to identify the possible mediators between them.

Methods: Information on educational level and lifestyle factors was collected through questionnaires. Diabetes was diagnosed from self-report and biochemical measurements. A structural equation model was constructed to quantify the mediation effect of each mediator.

Results: Compared with their least educated counterparts, men with college education had a higher risk of diabetes (odds ratio [OR] 1.19; 95% confidence interval [CI], 1.12-1.27), while college-educated women were less likely to have diabetes (OR 0.77; 95% CI, 0.73-0.82). Obesity was the strongest mediator in both genders (proportion of mediation: 11.6% in men and 23.9% in women), and its association with education was positive in men (β[SE] 0.0387 [0.0037]) and negative in women (β[SE] -0.0824 [0.0030]). Taken together, all behavioral factors explained 12.4% of the excess risk of diabetes in men and 33.3% in women.

Conclusions: In a general Chinese population, the association between education level and diabetes was positive in men but negative in women. Obesity was the major mediator underlying the education disparities of diabetes risk, with a stronger mediation effect among women.

目的: 在发展中国家，关于教育对糖尿病风险的影响的证据很少。我们的目的是在中国的一个大人群样本中探索教育和糖尿病之间的联系，并确定可能的中介因素。材料和方法: 通过问卷调查，收集有关文化程度和生活方式因素的信息。糖尿病的诊断是通过自我报告和生化测量进行的。我们构建了结构方程模型量化了各变量的中介效应。结果: 与受教育程度最低的男性相比，受过大学教育的男性患糖尿病风险较高(优势比OR:1.19, 95%可信区间(95%CI):1.12~1.27)，而受过大学教育的女性患糖尿病风险较低(OR:0.77, 95%CI:0.73~0.82)。肥胖在两性中均是最强的中介因素(中介比例:男性11.6%，女性23.9%)，肥胖与教育呈正相关(β[SE]0.0387[0.0037])，与女性中负相关(β[SE]-0.0824[0.0030])。所有行为因素加在一起，可以解释12.4%的男性和33.3%的女性患糖尿病的额外风险。结论: 在中国普通人群中，男性受教育程度与糖尿病之间存在正相关，而女性则为负相关。肥胖是糖尿病风险教育差异的主要中介因素，在女性中的中介作用更强。.

Keywords: diabetes; education; gender-dependent; mediation; obesity; 中介; 性别依赖; 教育; 糖尿病; 肥胖.

MeSH terms

China / epidemiology
Diabetes Mellitus* / diagnosis
Diabetes Mellitus* / epidemiology
Educational Status
Female
Humans
Male
Obesity* / complications
Risk Factors

Abstract in English, Chinese

MeSH terms

Grants and funding

Abstract
in English, Chinese