Socioeconomic inequalities in type 2 diabetes in employed individuals, nonworking spouses and pensioners.

Abstract

Type 2 diabetes (T2D) is a rising global epidemic with lower socioeconomic groups being more affected. Considering specific population subgroups to examine prevalence and socioeconomic inequalities in T2D is rare. Moreover, using one indicator to depict socioeconomic inequalities in health is a common practice despite evidence on differences in what different socioeconomic indicators ought to measure. This study has two aims:1. Examine the prevalence of T2D in employed individuals, nonworking spouses and pensioners.2. Examine socioeconomic inequalities in T2D in the three population subgroups and determine the explanatory power of income, education and occupation in employed individuals and nonworking spouses.This study is based on claims data from a statutory health insurance provider in Lower Saxony, Germany. T2D prevalence in the period between 2013 and 2017 was examined in employed individuals, nonworking spouses and pensioners. Multivariate logistic regression analysis was applied to examine socioeconomic inequalities in T2D in the three population subgroups. Explanatory power of the three socioeconomic indicators was determined by deviance analysis.Results showed that T2D prevalence was four times higher in male nonworking spouses (24.2%) and 2.6 times higher in female nonworking spouses (12.7%) compared to employed men (6.4%) and women (4.7%) respectively, while it accounted for 40% of men and 36% of women in pensioners. T2D inequalities emerged for all three socioeconomic indicators and were observed in the three subgroups. School education had the highest explanatory power in employed men and women and male nonworking spouses.Nonworking spouses are an important target group in T2D prevention interventions. The three socioeconomic indicators have independent effects and differ in their explanatory power where low school education appears to be a major risk factor. It can be discussed that health literacy and the associated health behavior play a role in mediating the association between school education and T2D.