Socioeconomic position and type 2 diabetes mellitus in Europe 1999-2009: a panorama of inequalities.

The aim of the present review is to synthesis findings from studies on the relationship between socioeconomic position (SEP) and incidence, prevalence and mortality of type 2 diabetes mellitus (T2DM) in Europe between the years 1999 and 2009. A systematic search was carried out in the National Library of Medicine's PubMed database. The search was limited to articles published between January 1999 and December 2009, in English or Spanish. Additional requirements for inclusion were: (i) presentation of empirical results directly related with SEP and the prevalence, incidence or mortality of diabetes, (ii) dealing with T2DM, (iii) carried out in Europe, and (iv) mainly focused only on diabetes. Of the 19 articles found, twelve studied the relationship between SEP and the prevalence of T2DM, two dealt with diabetes incidence, three with mortality and two studied both inequalities in mortality and prevalence. People with more deprived SEP have greater incidence, more prevalence and higher mortality due to T2DM, although the magnitude and significance of the associations varied from one study to another. Part of these inequalities is explained by SEP differences in the prevalence of the established T2DM risk factors. SEP inequalities in T2DM tended to be greater in women than in men. There is consistent evidence that SEP inequalities in T2DM incidence, prevalence and mortality are present in Europe, especially among women. Improving accessibility of physical activity in terms of both price and availability, access to healthy food, and access to health services, will be key to achieving a reduction of SEP related diabetes inequalities in Europe.