Abstract
ObjectiveThere is increasing evidence that prevention programmes for type 2 diabetes mellitus (T2DM) and obesity need to consider individual and regional risk factors. Our objective is to assess the independent association of area level deprivation with T2DM and obesity controlling for individual risk factors in a large study covering the whole of Germany.MethodsWe combined data from two consecutive waves of the national health interview survey ‘GEDA’ conducted by the Robert Koch Institute in 2009 and 2010. Data collection was based on computer-assisted telephone interviews. After exclusion of participants <30 years of age and those with missing responses, we included n = 33,690 participants in our analyses. The outcome variables were the 12-month prevalence of known T2DM and the prevalence of obesity (BMI ≥30 kg/m2). We also controlled for age, sex, BMI, smoking, sport, living with a partner and education. Area level deprivation of the districts was defined by the German Index of Multiple Deprivation. Logistic multilevel regression models were performed using the software SAS 9.2.ResultsOf all men and women living in the most deprived areas, 8.6% had T2DM and 16.9% were obese (least deprived areas: 5.8% for T2DM and 13.7% for obesity). For women, higher area level deprivation and lower educational level were both independently associated with higher T2DM and obesity prevalence [highest area level deprivation: OR 1.28 (95% CI: 1.05–1.55) for T2DM and OR 1.28 (95% CI: 1.10–1.49) for obesity]. For men, a similar association was only found for obesity [OR 1.20 (95% CI: 1.02–1.41)], but not for T2DM.ConclusionArea level deprivation is an independent, important determinant of T2DM and obesity prevalence in Germany. Identifying and targeting specific area-based risk factors should be considered an essential public health issue relevant to increasing the effectiveness of diabetes and obesity prevention.
Highlights
There is sound evidence that the prevalence of type 2 diabetes mellitus (T2DM) is strongly associated with obesity and that both T2DM and obesity are inversely associated with individual socioeconomic status (SES) [1,2,3,4]
Results from recent studies indicate that higher area level deprivation is significantly associated with greater risk of abnormal glucose tolerance and higher prevalence of T2DM and obesity, independently of individual SES [5,6], and that moving from a more deprived to a less deprived neighbourhood is associated with reductions in the prevalence of diabetes and obesity [7]
Two other studies based on this dataset indicate that regional differences in T2DM prevalence can partially be explained by the degree of area level deprivation at a municipality level [6] and by the neighbourhood unemployment rate in cities [12], independently of individual SES and established diabetes risk factors
Summary
There is sound evidence that the prevalence of type 2 diabetes mellitus (T2DM) is strongly associated with obesity and that both T2DM and obesity are inversely associated with individual socioeconomic status (SES) [1,2,3,4]. Two other studies based on this dataset indicate that regional differences in T2DM prevalence can partially be explained by the degree of area level deprivation at a municipality level [6] and by the neighbourhood unemployment rate in cities [12], independently of individual SES and established diabetes risk factors. Variation in the prevalence of T2DM and obesity has been demonstrated for German districts using small area estimation techniques [14]. This previous study did not consider individual characteristics, except age, sex and household size
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