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Understanding the complexity of socioeconomic disparities in type 2 diabetes risk: a study of 4.3 million people in Sweden
  1. Maria Wemrell1,2,
  2. Louise Bennet3,4,
  3. Juan Merlo1,4
  1. 1Unit for Social Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
  2. 2Department of Gender Studies, Lund University, Lund, Sweden
  3. 3Unit for Family and Community Medicine, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
  4. 4Center for Primary Health Care Research, Region Skåne, Malmö, Sweden
  1. Correspondence to Dr Maria Wemrell; maria.wemrell{at}med.lu.se

Abstract

Objective Investigating demographic and socioeconomic factors as intersecting rather than as separate dimensions may improve our understanding of the heterogeneous distribution of type 2 diabetes in the population. However, this complexity has scarcely been investigated and we still do not know the accuracy of these factors for predicting type 2 diabetes. Improved understanding of the demographic and socioeconomic disparities predicting type 2 diabetes risk in the population would contribute to more precise and effective public health interventions.

Research design and methods We analyzed the risk of type 2 diabetes among 4 334 030 individuals aged 40–84 years who by 2010 had resided in Sweden for at least 5 years. We stratified the study population into 120 strata defined by categories of age, gender, income, education, and immigration status. We calculated measures of absolute risk (prevalence) and relative risk (prevalence ratio), and quantified the discriminatory accuracy of the information for predicting type 2 diabetes in the population.

Results The distribution of type 2 diabetes risk in the population was highly heterogeneous. For instance, immigrated men aged 70–79 years with low educational achievement and low income had a risk around 32 times higher than native women aged 40–49 years with high income and high educational achievement (ie, 17.6% vs 0.5%). The discriminatory accuracy of the information was acceptable.

Conclusion A more detailed, intersectional mapping of socioeconomic and demographic distribution of type 2 diabetes can assist in public health management aiming to reduce the prevalence of the disease.

  • type 2 diabetes
  • epidemiology
  • social determinants

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • Contributors JM acquired the data, had the original idea for the paper, defined the database, directed the analyses, discussed and interpreted the results, and contributed to the writing of the paper. MW and LB made important contributions to the development of the concepts in the paper, the interpretation and discussion of the results, and the writing of the paper.

  • Funding The study has been supported by funds from the Swedish Research Council (no. 2017-01321, JM; and Strategic research area Exodiab no. 2009-1039, LB) and research funds from the Faculty of Medicine, Lund University (JM), Region Skåne County Council (JM), the Swedish Foundation for Strategic Research LUDC-IRC (no. IRC15-0067, LB), and Region Skåne ALF grants (LB).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.