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Socioeconomic Disparities in Insulin Resistance: Results From the Princeton School District Study

From the Department of Pediatrics, Tufts-New England Medical Center and Tufts University School of Medicine, Boston, MA (E.G.); Department of Pediatrics, Denver Children’s Hospital, and the University of Colorado School of Medicine, Denver, CO (S.R.D.); and the Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH (L.M.D.).

Address correspondence and reprint requests to Elizabeth Goodman, MD, Department of Pediatrics, Tufts-New England Medical Center, NEMC Box 351, 750 Washington Street, Boston, MA 02111. E-mail: egoodman{at}tufts-nemc.org

Objectives: The objectives of this study were to determine whether lower socioeconomic status (SES) is associated with changes in insulin resistance in adolescents over a 3-year period and explore moderators of this effect.

Methods: A total of 1167 healthy non-Hispanic black and white participants in the Princeton School District Study, a longitudinal study of fifth to 12th graders in a suburban Midwestern public school district were included in this study. Inclusion criteria were a) physical examination and fasting morning blood draw at baseline and 3 years later, b) younger than 20 years old at follow up, and c) information available on SES provided by a parent. The influence of SES on insulin resistance and change in insulin resistance over time was examined using general linear models adjusting for multiple covariates. Models also assessed if race or baseline weight status changed the SES–insulin resistance relationship and explored the role of perceived stress.

Results: Blacks and lower SES youth had higher body mass index z score and increased insulin resistance (p < .001). In multivariable models, lower parent education, but not household income, was associated with higher baseline insulin resistance (F = 7.84, p < .001) and worsening insulin resistance over time (F = 18.86, p < .001). Parent education’s effect on change in insulin resistance was more pronounced for obese youth compared with nonobese (F interaction = 10.12, p < .001) even with adjustment for multiple covariates. Perceived stress did not alter these relationships.

Conclusions: Lower parent education appears to be related to increased insulin resistance both cross-sectionally and over time in black and white adolescents. Worsening insulin resistance is especially problematic for obese adolescents from families with low parent education.

Key Words: obesity • insulin resistance • disparities • race • SES

Abbreviations: BMI = body mass index; CDC = Centers for Disease Control and Prevention; CV = coefficient of variation; HDL-C = high-density lipoprotein cholesterol; HOMA = homeostasis model assessment score; PSD = Princeton School District; SES = socioeconomic status.

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