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Abstract
Introduction To estimate the prevalence of and trends in diabetes according to sociodemographic indicators and cardiovascular risk factors in a Swiss population.
Research design and methods Annual cross-sectional study of adults residing in the state of Geneva. We included 9886 participants (51% women; mean age (SD) of 48.9 (13.4) years). Diagnosed diabetes was self-reported; undiagnosed diabetes was defined as having fasting plasma glucose level of ≥7 mmol/L and no previous diagnosis; total diabetes as the sum of diagnosed and undiagnosed diabetes. To assess trends, we grouped survey years into three time periods: 2005–2010, 2011–2014, and 2015–2017. To assess inequalities, we constructed the relative index of inequality (RII) and the slope index of inequality (SII) for education, income, and health insurance subsidy (state program based on socioeconomic disadvantage).
Results In total, 683 diabetes cases were identified. In 2015–2017, total diabetes prevalence was 11.8% (8.6%–14.9%) among lowest income participants, and 4.7% (3.4%–5.9%) among highest income participants (p<0.01). Similar findings were observed for education. Among participants with full health insurance subsidy, diabetes prevalence was 19.4% (12.1%–26.8%), and 6.1% (5.3%–7.0%) among those without (p<0.01). High diabetes prevalence was observed among participants who were men, older, overweight or obese, hypertensive, and hypercholesterolemic. Among participants with diabetes, 74.0% (63.5%–84.4%) in the lowest income group were diagnosed, compared with 90.2% (81.9%–98.4%) in the highest income group (p=0.04). Over the 13-year period, widening relative and absolute inequalities in total diabetes prevalence were observed for education and income. The education-RII (95% CI) increased from 1.51 (95% CI 1.01 to 2.32) in 2005–2010 to 2.54 (95% CI 1.58 to 4.07) in 2015–2017 (p=0.01), and the education-SII (95% CI) from 0.04 (95% CI 0.01 to 0.08) to 0.08 (95% CI 0.04 to 0.10; p<0.01). The income-RII increased from 2.35 (95% CI 1.44 to 3.84) to 3.91 (95% CI 2.24 to 6.85; p<0.01), and the income-SII from 0.08 (95% CI 0.04 to 0.12) to 0.011 (95% CI 0.07 to 0.14; p=0.01). Inequalities by health insurance subsidy were large (RII 3.56 (95% CI 1.90 to 6.66) and SII 0.10 (95% CI 0.05 to 0.15)) but stable across the study period.
Conclusion Among adults living in Geneva, Switzerland, substantial differences were observed in diabetes prevalence across socioeconomic and cardiovascular risk groups over a 13-year period, and relative and absolute socioeconomic inequalities appeared to have increased.
- adult diabetes
- social inequalities
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Footnotes
Contributors All authors designed the present study. CdM performed its statistical analyses and wrote the first draft of the manuscript. SS, IG and FRJ supervised the analyses, reviewed and provided critical comments on all drafts of the manuscript. IG and FRJ are the guarantors of the present study.
Funding This work was supported by a grant from the Fondation pour la Recherche sur le Diabète (Geneva, Switzerland).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The Bus Santé Study was approved by the University of Geneva Ethics Committee (IRB00003116) and all study participants provided informed written consent to participate in the study. The study complied with the Declaration of Helsinki.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon request from the corresponding author.