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Socioeconomic inequalities in type 2 diabetes in employed individuals, nonworking spouses and pensioners.

ABSTRACT: Type 2 diabetes (T2D) is a rising global epidemic with lower socioeconomic groups being more affected. Considering specific population subgroups to examine prevalence and socioeconomic inequalities in T2D is rare. Moreover, using one indicator to depict socioeconomic inequalities in health is a common practice despite evidence on differences in what different socioeconomic indicators ought to measure. This study has two aims: 1. Examine the prevalence of T2D in employed individuals, nonworking spouses and pensioners. 2. Examine socioeconomic inequalities in T2D in the three population subgroups and determine the explanatory power of income, education and occupation in employed individuals and nonworking spouses. This study is based on claims data from a statutory health insurance provider in Lower Saxony, Germany. T2D prevalence in the period between 2013 and 2017 was examined in employed individuals, nonworking spouses and pensioners. Multivariate logistic regression analysis was applied to examine socioeconomic inequalities in T2D in the three population subgroups. Explanatory power of the three socioeconomic indicators was determined by deviance analysis. Results showed that T2D prevalence was four times higher in male nonworking spouses (24.2%) and 2.6 times higher in female nonworking spouses (12.7%) compared to employed men (6.4%) and women (4.7%) respectively, while it accounted for 40% of men and 36% of women in pensioners. T2D inequalities emerged for all three socioeconomic indicators and were observed in the three subgroups. School education had the highest explanatory power in employed men and women and male nonworking spouses. Nonworking spouses are an important target group in T2D prevention interventions. The three socioeconomic indicators have independent effects and differ in their explanatory power where low school education appears to be a major risk factor. It can be discussed that health literacy and the associated health behavior play a role in mediating the association between school education and T2D.

SUBMITTER: Safieddine B

PROVIDER: S-EPMC7240220 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Socioeconomic inequalities in type 2 diabetes in employed individuals, nonworking spouses and pensioners.

Safieddine Batoul B Sperlich Stefanie S Beller Johannes J Lange Karin K Epping Jelena J Tetzlaff Juliane J Tetzlaff Fabian F Geyer Siegfried S

SSM - population health 20200511

Type 2 diabetes (T2D) is a rising global epidemic with lower socioeconomic groups being more affected. Considering specific population subgroups to examine prevalence and socioeconomic inequalities in T2D is rare. Moreover, using one indicator to depict socioeconomic inequalities in health is a common practice despite evidence on differences in what different socioeconomic indicators ought to measure. This study has two aims: 1. Examine the prevalence of T2D in employed individuals, nonworking s ...[more]

PMID: 32462074

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Project description:While socioeconomic inequalities in the prevalence and management of type 2 diabetes (T2D) are well established, little is known about whether inequalities exist in the prevalence and the temporal development of T2D comorbidities. Previous research points towards expansion of morbidity in T2D as depicted mainly by a rising trend of T2D comorbidities. Against this background, and using German claims data, this study aims to examine whether socioeconomic status (SES) inequalities exist in the rates and the temporal development of T2D comorbidities. Since previous research indicates varying risk levels for T2D prevalence in the population subgroups: working individuals, nonworking spouses and pensioners, the analyses are stratified by these three population subgroups. The study is done on a large population of statutory insured individuals with T2D in three time-periods between 2005 and 2017. Predicted probabilities of three comorbidity groups and the number of comorbidities were estimated using logistic and ordinal regression analyses among different income, education and occupation groups. Interaction analyses were applied to examine whether potential SES inequalities changed over time. The study showed that neither the cross-sectional existence, nor the temporal development of T2D comorbidities differed significantly among SES groups, ruling out SES inequalities in the prevalence and the temporal development of T2D comorbidities in Germany. In men and women of all examined population subgroups, predicted probabilities for less severe cardiovascular (CVD) comorbidities, other vascular diseases and the number of comorbidities per individual rose significantly over time regardless of SES, but little if any change took place for more severe CVD comorbidities. Another important finding is that the population subgroup of nonworking spouses had markedly higher predicted probabilities for most of the examined outcomes compared to working individuals. The study indicates that the expansion of morbidity in T2D in Germany does not appear to be SES-dependent, and applies equally to different population subgroups. Yet, the study highlights that nonworking spouses are a susceptible population subgroup that needs to be focused upon when planning and implementing T2D management interventions.

Project description:BackgroundThe prevalence of diabetes and the use of electronic health (eHealth) are increasing. People with diabetes need frequent monitoring and follow-up of health parameters, and eHealth services can be highly valuable. However, little is known about the use of eHealth in different socioeconomic groups among people with diabetes.ObjectiveThe aim of this study was to investigate the use of 4 different eHealth platforms (apps, search engines, video services, and social media sites) and the association with socioeconomic status (SES) among people diagnosed with type 1 and type 2 diabetes mellitus (T1D and T2D, respectively).MethodsWe used email survey data from 1250 members of the Norwegian Diabetes Association (aged 18-89 years), collected in 2018. Eligible for analyses were the 1063 respondents having T1D (n=523) and T2D (n=545). 5 respondents reported having both diabetes types and thus entered into both groups. Using descriptive statistics, we estimated the use of the different types of eHealth. By logistic regressions, we studied the associations between the use of these types of eHealth and SES (education and household income), adjusted for gender, age, and self-rated health.ResultsWe found that 87.0% (447/514) of people with T1D and 77.7% (421/542) of people with T2D had used 1 or more forms of eHealth sometimes or often during the previous year. The proportion of people using search engines was the largest in both diagnostic groups, followed by apps, social media, and video services. We found a strong association between a high level of education and the use of search engines, whereas there were no educational differences for the use of apps, social media, or video services. In both diagnostic groups, high income was associated with the use of apps. In people with T1D, lower income was associated with the use of video services.ConclusionsThis paper indicates a digital divide among people with diabetes in Norway, with consequences that may contribute to sustaining and shaping inequalities in health outcomes. The strong relationship between higher education and the use of search engines, along with the finding that the use of apps, social media, and video services was not associated with education, indicates that adequate communication strategies for audiences with varying education levels should be a focus in future efforts to reduce inequalities in health outcomes.

Project description:ObjectiveThe contribution of smoking to socioeconomic inequalities in health is increasing worldwide, including in Brazil. Youth smoking may play an important role in the increasing social inequalities related to smoking. This study investigates social determinants of smoking among 15-year-old to 19-year-old individuals.DesignCross-sectional study.SettingThe study uses data of 3536 participants aged 15-19 years of age of the Global Adult Tobacco Survey (GATS) and the National Household Sample Survey (Pesquisa Nacional por Amostragem de Domicilio, PNAD) obtained from household interviews. Smoking was defined as currently smoking tobacco products, regardless of frequency. Household socioeconomic indicators included per capita income, the educational level and sex of the head of the household, the presence of smoking restrictions and the number of smokers (excluding adolescents). Adolescent social factors included years of delaying school and social status (full-time student, working, and neither working nor studying). The hierarchical logistic regression analysis considered the effect of the complex sampling design.ResultsFrom 3536 participants, 6.2% were smokers (95% CI 5.4 to 7.1). More men than women had the habit of smoking (7.2%; 5.9 to 8.6 vs 3.6%; 2.7 to 4.6). The likelihood of smoking was significantly greater for men and older teens. There was an upward trend in the OR of smoking according to the number of smokers in the house. Adolescents living in households with no smoking restrictions had a greater likelihood of being smokers. OR of smoking rose as the number of years of delaying school increased, being about three times greater among adolescents who were working and five times greater among those who were neither studying nor working.ConclusionsResults demonstrate that socioeconomic inequality in smoking is established at younger ages and that school delay as well as school abandonment may contribute to increased smoking-related inequalities. Smoking restrictions at home were protective against adolescents becoming smokers. Living with other smokers was a strong predictor of adolescents becoming smokers.

Dataset Information

Socioeconomic inequalities in type 2 diabetes in employed individuals, nonworking spouses and pensioners.

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Socioeconomic inequalities in type 2 diabetes in employed individuals, nonworking spouses and pensioners.

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