Diabetes Metab J.  2023 Sep;47(5):682-692. 10.4093/dmj.2022.0184.

Low Household Income Status and Death from Pneumonia in People with Type 2 Diabetes Mellitus: A Nationwide Study

  • 1Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 2Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 3Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
  • 4Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea


We explored the risk of death from pneumonia according to cumulative duration in low household income state (LHIS) among adults with type 2 diabetes mellitus (T2DM).
Using Korean National Health Insurance Service data (2002 to 2018), the hazards of mortality from pneumonia were analyzed according to duration in LHIS (being registered to Medical Aid) during the 5 years before baseline (0, 1–4, and 5 years) among adults with T2DM who underwent health examinations between 2009 and 2012 (n=2,503,581). Hazards of outcomes were also compared in six groups categorized by insulin use and duration in LHIS.
During a median 7.18 years, 12,245 deaths from pneumonia occurred. Individuals who had been exposed to LHIS had higher hazards of death from pneumonia in a dose-response manner (hazard ratio [HR], 1.726; 95% confidence interval [CI], 1.568 to 1.899 and HR, 4.686; 95% CI, 3.948 to 5.562 in those exposed for 1–4 and 5 years, respectively) compared to the non-exposed reference. Insulin users exposed for 5 years to LHIS exhibited the highest outcome hazard among six groups categorized by insulin use and duration in LHIS.
Among adults with T2DM, cumulative duration in LHIS may predict increased risks of mortality from pneumonia in a graded dose-response manner. Insulin users with the longest duration in LHIS might be the group most vulnerable to death from pneumonia among adults with T2DM.


Diabetes mellitus, type 2; Income; Mortality; Pneumonia; Social class


  • Fig. 1. Flow diagram of the study population.

  • Fig. 2. Cumulative incidence of death from pneumonia according to exposure duration to low household income state. The dashed lines represent the 95% confidence intervals.

  • Fig. 3. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for death from pneumonia in subjects with versus without exposure to low household income state according to subgroups. Adjusted for age, sex, smoking history, alcohol consumption, regular exercise, presence of chronic kidney disease, fasting plasma glucose, and diabetes duration (≥5 years vs. <5 years).


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