BACKGROUND: Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide. In high-income countries, low socioeconomic status seems to be related to a high incidence of T2DM, but very little is known about the intermediate factors of this relationship. Method We performed a case-cohort study in eight Western European countries nested in the EPIC study (n = 340, 234, 3.99 million person-years of follow-up). A random sub-cohort of 16,835 individuals and a total of 12,403 incident cases of T2DM were identified. Crude and multivariate-adjusted hazard ratios (HR) were estimated for each country and pooled across countries using meta-analytical methods. Age-, gender- and country-specific relative indices of inequality (RII) were used as the measure of educational level and RII tertiles were analysed. RESULTS: Compared with participants with a high educational level (RII tertile 1), participants with a low educational level (RII tertile 3) had a higher risk of T2DM [HR: 1.77, 95% confidence interval (CI): 1.69-1.85; P-trend < 0.01]. The HRs adjusted for physical activity, smoking status and propensity score according to macronutrient intake were very similar to the crude HR (adjusted HR: 1.67, 95% CI: 1.52-1.83 in men; HR: 1.88, 95% CI: 1.73-2.05 in women). The HRs were attenuated only when they were further adjusted for BMI (BMI-adjusted HR: 1.36, 95% CI: 1.23-1.51 in men; HR: 1.32, 95% CI: 1.20-1.45 in women). CONCLUSION: This study demonstrates the inequalities in the risk of T2DM in Western European countries, with an inverse relationship between educational level and risk of T2DM that is only partially explained by variations in BMI.
BACKGROUND:Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide. In high-income countries, low socioeconomic status seems to be related to a high incidence of T2DM, but very little is known about the intermediate factors of this relationship. Method We performed a case-cohort study in eight Western European countries nested in the EPIC study (n = 340, 234, 3.99 million person-years of follow-up). A random sub-cohort of 16,835 individuals and a total of 12,403 incident cases of T2DM were identified. Crude and multivariate-adjusted hazard ratios (HR) were estimated for each country and pooled across countries using meta-analytical methods. Age-, gender- and country-specific relative indices of inequality (RII) were used as the measure of educational level and RII tertiles were analysed. RESULTS: Compared with participants with a high educational level (RII tertile 1), participants with a low educational level (RII tertile 3) had a higher risk of T2DM [HR: 1.77, 95% confidence interval (CI): 1.69-1.85; P-trend < 0.01]. The HRs adjusted for physical activity, smoking status and propensity score according to macronutrient intake were very similar to the crude HR (adjusted HR: 1.67, 95% CI: 1.52-1.83 in men; HR: 1.88, 95% CI: 1.73-2.05 in women). The HRs were attenuated only when they were further adjusted for BMI (BMI-adjusted HR: 1.36, 95% CI: 1.23-1.51 in men; HR: 1.32, 95% CI: 1.20-1.45 in women). CONCLUSION: This study demonstrates the inequalities in the risk of T2DM in Western European countries, with an inverse relationship between educational level and risk of T2DM that is only partially explained by variations in BMI.
Authors: M Asadi-Lari; A Khosravi; S Nedjat; M A Mansournia; R Majdzadeh; K Mohammad; M R Vaez-Mahdavi; S Faghihzadeh; A A Haeri Mehrizi; B Cheraghian Journal: J Endocrinol Invest Date: 2015-09-10 Impact factor: 4.256
Authors: Jacqueline A Seiglie; Maja-Emilia Marcus; Cara Ebert; Nikolaos Prodromidis; Pascal Geldsetzer; Michaela Theilmann; Kokou Agoudavi; Glennis Andall-Brereton; Krishna K Aryal; Brice Wilfried Bicaba; Pascal Bovet; Garry Brian; Maria Dorobantu; Gladwell Gathecha; Mongal Singh Gurung; David Guwatudde; Mohamed Msaidié; Corine Houehanou; Dismand Houinato; Jutta Mari Adelin Jorgensen; Gibson B Kagaruki; Khem B Karki; Demetre Labadarios; Joao S Martins; Mary T Mayige; Roy Wong-McClure; Joseph Kibachio Mwangi; Omar Mwalim; Bolormaa Norov; Sarah Quesnel-Crooks; Bahendeka K Silver; Lela Sturua; Lindiwe Tsabedze; Chea Stanford Wesseh; Andrew Stokes; Rifat Atun; Justine I Davies; Sebastian Vollmer; Till W Bärnighausen; Lindsay M Jaacks; James B Meigs; Deborah J Wexler; Jennifer Manne-Goehler Journal: Diabetes Care Date: 2020-02-12 Impact factor: 19.112
Authors: Mei Yang; Han Cheng; Chaowei Shen; Jie Liu; Hongkai Zhang; Jiyu Cao; Rui Ding Journal: Environ Sci Pollut Res Int Date: 2019-12-06 Impact factor: 4.223
Authors: Sridharan Raghavan; Mark C Pachucki; Yuchiao Chang; Bianca Porneala; Caroline S Fox; Josée Dupuis; James B Meigs Journal: J Gen Intern Med Date: 2016-05-04 Impact factor: 5.128
Authors: Rachel Gold; Arwen Bunce; Stuart Cowburn; Katie Dambrun; Marla Dearing; Mary Middendorf; Ned Mossman; Celine Hollombe; Peter Mahr; Gerardo Melgar; James Davis; Laura Gottlieb; Erika Cottrell Journal: Ann Fam Med Date: 2018-09 Impact factor: 5.166
Authors: Bjorn Kluwe; Robin Ortiz; James B Odei; Songzhu Zhao; David Kline; Guy Brock; Justin B Echouffo-Tcheugui; Ju-Mi Lee; Sophie Lazarus; Teresa Seeman; Philip Greenland; Belinda Needham; Mercedes R Carnethon; Sherita H Golden; Joshua J Joseph Journal: Psychoneuroendocrinology Date: 2020-11-04 Impact factor: 4.905