Socioeconomic Deprivation as Measured by the Index of Multiple Deprivation and Its Association with Low Sex Hormone Binding Globulin in Women
Adrian Heald1, 2, *, Ian Laing1, David J. McLernon3, Rachelle Donn2, Andrew J. Hartland5, Anthony A. Fryer4, Mark Livingston5
1 Department of Medicine, Leighton Hospital, Crewe, United Kingdom
2 School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
3 Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
4 Department of Clinical Biochemistry, Keele University School of Medicine, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom
5 Department of Blood Sciences, Walsall Manor Hospital, Walsall, United Kingdom
Sex hormone binding globulin (SHBG) is a marker of insulin resistance. Given established links between BMI and socioeconomic disadvantage, we investigated how SHBG varies by index of multiple deprivation (IMD).
Research Design and Methods:
Using laboratory data from a Midlands UK population of mixed ethnicity, we examined the relation between blood concentrations of SHBG and IMD in 1160 women aged between 17 and 71 years. Women with a serum SHBG >250 nmol/L were excluded.
Mean age was 28.7 (95% confidence interval (CI) 28.2–29.1) years. 48.2% of women were of Caucasian origin, 15.5% of Southern Asian ethnicity and 2.6% were of African or other origin (33.7% were of unknown origin).
SHBG increased with age (Spearman’s ρ=0.195; p<0.001). A higher proportion of women of South Asian origin versus other ethnic groups had an SHBG <30 nmol/L (OR 1.93 (95% CI 1.37–2.71)).
SHBG level was lower in individuals with greater socioeconomic disadvantage as measured by IMD (Spearman's ρ= -0.09; p=0.004 for SHBG versus IMD).
In multivariate logistic regression, IMD women in the quartiles 2–5 (higher socioeconomic disadvantage) were more likely to have an SHBG <30 nmol/L (compatible with significant insulin resistance) versus quartile 1 (odds ratio (OR) 1.71 (95% confidence interval (CI) 1.17–2.53), adjusted for age (OR=0.97 (95% CI 0.95–0.98)) and ethnicity (for South Asian ethnicity OR=2.00 (95% CI 1.42–2.81) versus the rest).
Lower SHBG levels in women are associated with a higher level of socioeconomic disadvantage. Given the known association between lower SHBG and higher plasma glucose, our findings suggest a link between socioeconomic disadvantage and future risk of type 2 diabetes.
Keywords: Sex hormone binding globulin, Index of multiple deprivation, Type 2 diabetes, Women, BMI, Ethnicity.
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* Address correspondence to this author at the School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; Tel: +44 1270 612353; Fax: +44 1270 613353; E-mail: email@example.com