Abstract
BackgroundType 2 diabetes is associated with low socioeconomic position (SEP) in high-income countries. Despite the important role of SEP in the development of many diseases, no socioeconomic indicator was included in the Comparative Risk Assessment (CRA) module of the Global Burden of Disease study. We therefore aimed to illustrate an example by estimating the burden of type 2 diabetes in Sweden attributed to lower educational levels as a measure of SEP using the methods applied in the CRA.MethodsTo include lower educational levels as a risk factor for type 2 diabetes, we pooled relevant international data from a recent systematic review to measure the association between type 2 diabetes incidence and lower educational levels. We also collected data on the distribution of educational levels in the Swedish population using comparable criteria for educational levels as identified in the international literature. Population attributable fractions (PAF) were estimated and applied to the burden of diabetes estimates from the Swedish burden of disease database for men and women in the separate age groups (30-44, 45-59, 60-69, 70-79, and 80+ years).ResultsThe PAF estimates showed that 17.2% of the diabetes burden in men and 20.1% of the burden in women were attributed to lower educational levels in Sweden when combining all age groups. The burden was, however, most pronounced in the older age groups (70-79 and 80+), where lower educational levels contributed to 22.5% to 24.5% of the diabetes burden in men and 27.8% to 32.6% in women.ConclusionsThere is a considerable burden of type 2 diabetes attributed to lower educational levels in Sweden, and socioeconomic indicators should be considered to be incorporated in the CRA.
Highlights
Type 2 diabetes is associated with low socioeconomic position (SEP) in high-income countries
Age by adjustment Age, BMI, physical activity, quintile of dietary score, alcohol consumption, smoking baseline hypertension + hypercholesterolemia, FHD, menopausal, use of HRT, ethnicity, birth weight, breastfeeding, and childhood SEP by adjustment a Risk estimate calculated from crude data *Ages at baseline or at diagnosis, for cases only or total, depending on reporting, given as mean or age range RR = relative risk, CI = confidence interval, BMI = body mass index, WHR = waist-hip-ratio, FHD = family history of diabetes, HRT = hormone replacement therapy, SEP = socioeconomic position same classification of education was used for Swedish data as we found in the systematic reviews and metaanalyses from the international literature
Type 2 diabetes incidence and low educational level In men, the pooled RR for middle and low compared to high educational level was 1.16 and 1.52 (1.28-1.82), and in women the corresponding estimates were 1.18 (1.07-1.31) and 1.71 (1.07-2.74) (Table 2)
Summary
Type 2 diabetes is associated with low socioeconomic position (SEP) in high-income countries. We aimed to illustrate an example by estimating the burden of type 2 diabetes in Sweden attributed to lower educational levels as a measure of SEP using the methods applied in the CRA. We attempt, as a first step, to illustrate an example by estimating the burden of type 2 diabetes in Sweden attributed to lower educational levels as a measure of SEP using the methods applied in CRA. By this example and by the discussion of our findings and limitations, we hope that further efforts and debates will emerge about the possibilities of including socioeconomic indicators in CRA and burden of disease estimates
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