Health Inequalities : Health Inequalities - Inequalities in diabetes mellitus

Inequalities in the prevalence of diabetes

In earlier studies on the association between socioeconomic position and diabetes prevalence, a disadvantaged socioeconomic position was related to a higher prevalence of diabetes (Dalstra et al., 2005; Larranaga et al., 2005; Abu et al., 1997; Connolly et al., 2000; Brown et al., 2004; Kumari et al., 2004; Wray et al., 2006).

This association was confirmed in a more recent study on socioeconomic inequalities in the prevalence of diabetes in different areas of Europe (Espelt et al., 2007). In the majority of the studied countries, people with a higher socioeconomic position have a prevalence of diabetes of around 3%. People with a lower socioeconomic position have a higher prevalence of diabetes, which is around 5%. Inequalities in the prevalence of diabetes are larger in women than in men. In men, the majority of countries show weak associations between socioeconomic position and diabetes, while in women these associations are clearer. These differences are more accentuated in Western countries, both in women as in men.

See Chart Age-standardised prevalence ratio of diabetes by educational level in men and women, 30-64 years of age in selected countries.

Obesity and diabetes

Diabetes and obesity are strongly linked but the prevalence of both diabetes and obesity varies throughout populations. In Western countries, the risk of developing diabetes and/or risk factors associated with diabetes is linked to a low socioeconomic position (Connolly & Kesson, 1996; Connolly et al., 2000; Evans et al., 2000; Hjelm et al., 1996).

In most countries, a lower educational level was associated with a relatively high prevalence of diabetes. Among people with a lower education diabetes was 1.5 and 2.7 times more common for men and women, respectively. Obesity was 1.6 and 1.9 times more common for men and women with lower education. Inequalities in both diabetes and obesity were generally larger among women, especially among those from southern European countries. Combating inequalities in obesity prevalence is very likely to also impact inequalities in diabetes (Roskam & Kunst, 2007).

Also see EUphacts Overweight and Diabetes..

Schrijvers C (RIVM), Kunst AE (EUR-MGZ), Bovendeur I (RIVM). Health Inequalities - Inequalities in diabetes mellitus. In: EUPHIX, EUphocus. Bilthoven: RIVM, <http://www.euphix.org> EUphocus\ Health Inequalities, 5 June 2008.

Literature and data sources

Abu SM, Ali L, Hussain MZ, Rumi MA, Banu A, Azad Khan AK. Effect of socioeconomic risk factors on the difference in prevalence of diabetes between rural and urban populations in Bangladesh. Diabetes Care, 1997; 20: 551-555.

Brown AF, Ettner SL, Piette J, Weinberger M, Gregg E, Shapiro MF, et al. Socioeconomic position and health among persons with diabetes mellitus: a conceptual framework and review of the literature. Epidemiol. Rev., 2004; 26: 63-77.

Connolly V, Kesson CM. Socioeconomic status and clustering of cardiovascular disease risk factors in diabetic patients. Diabetes Care, 1996; 19: 419-422.

Connolly V, Unwin N, Sherriff P, Bilous R, Kelly W. Diabetes prevalence and socioeconomic status: a population based study showing increased prevalence of type 2 diabetes mellitus in deprived areas. J. Epidemiol. Community Health, 2000; 54: 173-177.

Dalstra JA, Kunst AE, Borrell C et al. Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries. Int J Epidemiol, 2005; 34(2): 316-326.

Espelt A, Borrell C, Rodriquez-Sanz M, Roskam A-J, Dalmau A, Mackenbach J, et al. Socio-economic inequalities in diabetes mellitus across Europe at the turn of the century. Chapter 9. In: Tackling Health Inequalities in Europe: an Integrated Approach. Eurothine Final Report. Rotterdam: Department of Public Health, University Medical Centre Rotterdam, 2007.

Evans JM, Newton RW, Ruta DA, MacDonald TM, Morris AD. Socioeconomic status, obesity and prevalence of type 1 and type 2 diabetes mellitus. Diabetic Medicine, 2000: 478-480.

Hjelm KSJ, Nyberg P, Apelqvist J, Isacson A. Foreign- and Swedish-born diabetic patients – a population-based study of prevalence, glycaemic control and socialposition. Scand. J. Soc. Med., 1996;: 243-252.

Kumari M, Head J, Marmot M. Prospective study of social and other risk factors for incidence of type 2 diabetes in the Whitehall II study. Arch. Intern. Med., 2004; 164: 1874-1880.

Larranaga I, Arteagoitia JM, Rodriquez JL, Gonzalez F, Esnaola S, Pinies JA. Socioeconomic inequalities in the prevalence of Type 2 diabetes, cardiovascular risk factors and chronic diabetic complications in the Basque Country, Spain. Diabet. Med., 2005; 22: 1047-1053.

Roskam AJ, Kunst AE. Overview of inequalities and overweight across Europe. Chapter 23. In: Tackling Health Inequalities in Europe: an Integrated Approach. Eurothine Final Report. Rotterdam: Department of Public Health, University Medical Centre Rotterdam, 2007.

Wray LA, Alwin DF, McCammon RJ, Manning T, Best LE. Social status, risky health behaviors and diabetes in middle-aged and older adults. J. Gerontol.B Psychol. Sci.Sco.Sci., 2006; 61: S290-S298.