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Social Status, Risky Health Behaviors, and Diabetes in Middle-Aged and Older Adults

¹ Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania.
² Department of Sociology, The Pennsylvania State University, University Park, Pennsylvania.
³ Institute for Social Research, University of Michigan, Ann Arbor, Michigan.
⁴ Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.

Address correspondence to Linda A. Wray, PhD, Department of Biobehavioral Health, The Pennsylvania State University, 315 East Health and Human Development, University Park, PA 16802. E-Mail: law30{at}psu.edu

Objectives. This article investigates: (a) how social status influences diabetes prevalence and incidence; (b) how risky health behaviors contribute to the prediction of incident diabetes; (c) if the effects of health behaviors mediate the effects of social status on incident diabetes; and (d) if these effects differ in midlife and older age.

Methods. We examined nationally representative data from the 1992/1993–1998 panels of the Health and Retirement Study for middle-aged and older adults using logistic regression analyses.

Results. The odds of prevalent diabetes were higher for people of older age, men, Black adults, and Latino adults. Higher early-life social status (e.g., parental schooling) and achieved social status (e.g., respondent schooling, economic resources) reduced the odds in both age groups. We observed similar patterns for incident diabetes in midlife but not in older age. Risky health behaviors—particularly obesity—increased the odds of incident diabetes in both age groups independent of social status. The increased odds of incident diabetes in midlife persisted for Black and Latino adults net of other social status factors.

Discussion. Risky health behaviors are key predictors of incident diabetes in both age groups. Economic resources also play an important protective role in incident diabetes in midlife but not in older age.