This study was an up-to-date complement to literatures regarding the SES of rural population. Because all participants were farmer in this research, a new measure of SES was proposed. With few exceptions, the results unequivocally showed that SES of men, however defined, was higher than women in each age group among rural population. This disparity increased with age. Additionally, increasing age corresponded to decreasing SES and the old one had the worst SES-score. Divergent associations between SES and T2DM across gender were also caught in this research. SES was positively associated with prevalent T2DM in men but negatively in women.
In analyses stratified by gender, we observed men always had a higher SES-score than women among rural population. Virtually, previous study had indicated that sizeable gender gap in SES remained to data in all countries, which would take 99.5 years to close even at a fast rate.18 In rural China, with the widely available of base education, the education level had a great improvement, especially for women.19 In our research, thus, the gender gap in education was only salient in old people, who did not or limitedly enjoy the free education benefits. Although the popularization of gender equality ideology has been proposed, influenced by the traditional culture preference for men, women still earned on average 20% less than men on an hourly basis.20,21 The limited mechanization or services resources of housework in rural areas forced women to do most of housework, which fueled markedly increased the gender gap in income.22 With age increasing, both old men and women may drop out of the labor market, so this gap in income would close and was not observed in our results among old participants. In China, the legal age for marriage is 20 for women but 22 for men, which may account for the higher marital SES-score in youth women. However, due to the longer life expectancy of women,23 old women were more likely to lose their partner than old men. Thus, the gender gap in marital status reversed with age.
Gender difference in association between SES and T2DM had been pronounced early.24 In this research, we found T2DM was more prevalent among low-SES group in women, whereas an opposite pattern was observed in men. Irrespective of disease and the measure of SES, previous studies conducted in China also observed the similar situation.25,26 In rural areas, due to the limited medical resource, higher income group had more access to higher quality medical services.27,28 And the high education status may increase the awareness of diseases and thus made individuals maintain a healthy lifestyle.29 It was reasonable to indicate that high SES would correspond to the decreased prevalence of T2DM among rural women. Considering that men provided the main source of household income in rural China, one of the reasons for the divergent association among men could be attributed to the psychological stress.30,31 Additionally, due to men with high SES were more likely to drink or smoke, the impact of SES on T2DM may be covered by unhealthy lifestyles.32,33
Considering marriage or remarriage usually cost an enormous amount of money in rural areas and thus people with low SES would not have a wonderful marriage, marital status was regarded as an indicator of SES-score in this research.34 Compared with educational level, the association between T2DM and income was more confusing and not significantly detected after adjustment with various variables. This could be attribute to the collinearity, which meant the correlation among education, income, and marital status were moderate but significant.35 Another possible explanation was that educational level was more strongly associated with individuals’ health-promoting behaviors than income.36
Despite diverse sources and divergent measurements of SES, the consistent overall view was that low SES group cost more in T2DM care due to the inadequate management of T2DM.37 These extra costs plunge low-SES group into a vicious cycle of further economic burden and limited management, resulting in more economic hardship.38 Considering SES may virtually pattern all health behaviors, it is our desire that results published here would stimulate private sectors to act. Increasing the publicity of gender equality ideology as well as making practical policies to improve the SES of women were advisable ways to maintain social harmony in rural China. With regard to T2DM prevention, gender-specific strategies should be an integral component. For men, more concentration should be attached to their lifestyles, while for women, more allowance should be provided.
Our findings may provide a complement to literature regarding the association between SES and T2DM among rural population. Although the large sample size and an appropriate measurement of SES made our results more convincing, some limitations should be noted. Firstly, only three economy-related indicators were included in SES-score, which may not accurately represent the SES of individuals. Secondly, the score of each level in three compositions was equivalent, while the effect of each level may be complicated in different conditions. Thirdly, because all participants in this research were farmers, this new measurement of SES could not be generalized for urban population. Moreover, the cross-sectional study could only provide an association but a causation. Therefore, further investigations are warranted to confirm the extensibility of our findings.
In conclusion, via a new measurement of SES, this study observed a gender gap in SES among rural population. Men always had a higher SES-score than women and this gap increased with age. The association between SES and T2DM differed qualitatively between men and women. Old men with high SES and old women with low SES were two vulnerable subgroups for T2DM.