Jimmi Mathisen1, Aksel K G Jensen2,3, Ingelise Andersen4, Gregers S Andersen5, Ulla A Hvidtfeldt6, Naja H Rod7. 1. Section of Epidemiology, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1353, Copenhagen, Denmark. jima@sund.ku.dk. 2. Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. 3. Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, USA. 4. Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. 5. Steno Diabetes Center Copenhagen, Capital Region, Gentofte, Denmark. 6. Danish Cancer Society Research Center, Copenhagen, Denmark. 7. Section of Epidemiology, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1353, Copenhagen, Denmark.
Abstract
AIMS/HYPOTHESIS: Educational inequality in type 2 diabetes incidence is evident in many high-income countries. Previous studies have shown that differential exposure to being overweight/obese across educational groups may partly explain this inequality. Whether differential susceptibility to being overweight/obese across educational groups contributes to this inequality has been investigated less frequently, even though it is a plausible mechanism. The two mechanisms may even be highly intertwined. In this longitudinal cohort study, we investigated the simultaneous contribution of differential exposure and differential susceptibility to being overweight/obese to educational inequality in type 2 diabetes incidence. METHODS: The study population comprised 53,159 Danish men and women aged 50-64 years at baseline who were followed for a mean of 14.7 years. We estimated rate differences of type 2 diabetes by education level per 100,000 person-years. Using counterfactual mediation analysis, these rate differences were decomposed into proportions attributable to differential exposure, differential susceptibility and all other pathways, respectively. We compared this approach with conventional approaches to mediation and interaction analysis. RESULTS: Compared with a high level of education, a low education level was associated with 454 (95% CI 398, 510) additional cases of type 2 diabetes, and a medium education level with 316 (CI 268, 363) additional cases. Differential exposure to being overweight/obese accounted for 37% (CI 31%, 45%) of the additional cases among those with a low education level and 29% (CI 24%, 36%) of the additional cases among those with a medium education level. Differential susceptibility accounted for 9% (CI 4%, 14%) and 6% (CI 3%, 10%) of the additional cases among those with a low and medium education level, respectively. Compared with the counterfactual approach, the conventional approaches suggested stronger effects of both mechanisms. CONCLUSIONS/ INTERPRETATION: Differential exposure and susceptibility to being overweight/obese are both important mechanisms in the association between education and type 2 diabetes incidence.
AIMS/HYPOTHESIS: Educational inequality in type 2 diabetes incidence is evident in many high-income countries. Previous studies have shown that differential exposure to being overweight/obese across educational groups may partly explain this inequality. Whether differential susceptibility to being overweight/obese across educational groups contributes to this inequality has been investigated less frequently, even though it is a plausible mechanism. The two mechanisms may even be highly intertwined. In this longitudinal cohort study, we investigated the simultaneous contribution of differential exposure and differential susceptibility to being overweight/obese to educational inequality in type 2 diabetes incidence. METHODS: The study population comprised 53,159 Danish men and women aged 50-64 years at baseline who were followed for a mean of 14.7 years. We estimated rate differences of type 2 diabetes by education level per 100,000 person-years. Using counterfactual mediation analysis, these rate differences were decomposed into proportions attributable to differential exposure, differential susceptibility and all other pathways, respectively. We compared this approach with conventional approaches to mediation and interaction analysis. RESULTS: Compared with a high level of education, a low education level was associated with 454 (95% CI 398, 510) additional cases of type 2 diabetes, and a medium education level with 316 (CI 268, 363) additional cases. Differential exposure to being overweight/obese accounted for 37% (CI 31%, 45%) of the additional cases among those with a low education level and 29% (CI 24%, 36%) of the additional cases among those with a medium education level. Differential susceptibility accounted for 9% (CI 4%, 14%) and 6% (CI 3%, 10%) of the additional cases among those with a low and medium education level, respectively. Compared with the counterfactual approach, the conventional approaches suggested stronger effects of both mechanisms. CONCLUSIONS/ INTERPRETATION: Differential exposure and susceptibility to being overweight/obese are both important mechanisms in the association between education and type 2 diabetes incidence.
Entities:
Keywords:
BMI; Diabetes mellitus, type 2; Educational status; Health status disparities; Mediation analysis; Obesity; Overweight; Socioeconomic factors; Susceptibility
Authors: Giacomo Pietro Vigezzi; Paola Bertuccio; Camilla Bonfadini Bossi; Andrea Amerio; Luca Cavalieri d'Oro; Giuseppe Derosa; Licia Iacoviello; David Stuckler; Alberto Zucchi; Alessandra Lugo; Silvano Gallus; Anna Odone Journal: Prim Care Diabetes Date: 2022-06-20 Impact factor: 2.567
Authors: Jia Zhang; Zekai Chen; Katri Pärna; Sander K R van Zon; Harold Snieder; Chris H L Thio Journal: Diabetologia Date: 2022-04-28 Impact factor: 10.460
Authors: Mette A Nexø; Jacob Pedersen; Bryan Cleal; Ingelise Andersen; Jakob B Bjørner Journal: Scand J Work Environ Health Date: 2021-06-08 Impact factor: 5.024