Socioeconomic inequalities in type 2 diabetes and job demands/control/support - The Maastricht Study

Abstract

Abstract Background Low socioeconomic position (SEP) is an important determinant of Type 2 Diabetes Mellitus (T2DM). Adverse environments in the exposome might be involved; however, the environmental factors are under-studied compared to lifestyle. We explored low job control, high job demands, and low job support as pathways between SEP and T2DM. Methods Cross-sectional and longitudinal data from 8,090 participants of The Maastricht Study were used. Prevalent T2DM was measured by an oral glucose tolerance test and incident T2DM was self-reported in annual follow-up questionnaires. SEP was operationalized by baseline measures of education, occupation, and income. The work stressors were measured by questionnaires at baseline. For Cox regression, the survival time was computed by midpoint imputation. The associations of SEP, job demands, control, and support with T2DM were examined as well as the mediating role of the work stressors by using a counterfactual framework. Results 2.8% (N = 172) of the participants without T2DM at baseline reported incident T2DM. People with lower SEP were more likely to report T2DM during the follow-up course (e.g.; education HR = 2.21, 95%CI: 1.53-3.20) and more often had prevalent T2DM. Low job control was associated with prevalent T2DM (OR = 1.44 95%CI: 1.25-1.67), but not with incident T2DM. Job control explained 7.23% of the relationship between income and prevalent T2DM. Job demand suppressed the relationship of education (3.65%) and occupation (3.72%) with prevalent T2DM. Conclusions Our findings provide modest evidence for environmental injustice in T2DM exposome. The substantial higher risks of diabetes in low SEP is to a small extent explained by lower control at work. Furthermore, by having lower psychosocial job demands, they are protected against T2DM. Key messages • Job demands and control play a role in SEP and prevalent T2DM relationship. • Work stressors might not be a major target for tackling socioeconomic inequalities in type 2 diabetes.