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Published on: April 26, 2019
Association between regional deprivation and type 2 diabetes incidence in Germany
Esther Jacobs1,2, Thaddäus Tönnies1, Wolfgang Rathmann1,2
1Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Objective:
The aim of this analysis was to estimate the association between regional deprivation and type 2 diabetes incidence and to investigate differences by age and sex for Germany.
Research Design And Methods:
Type 2 diabetes incidence rate ratios comparing the most deprived fifth of the population to the remainder of the population (divided into quintiles) were estimated using the illness-death model, which describes the relationship between prevalence, mortality, and incidence. For the analysis, we used the type 2 diabetes prevalence and the general mortality rate according to deprivation quintiles, which we calculated based on valid estimates for Germany. Because mortality rate ratios for people with type 2 diabetes compared with people without type 2 diabetes are lacking for Germany, we used estimates from Scotland. Estimates were standardized to the German population in 2012 and stratified by sex.
Results:
Incidence of type 2 diabetes was estimated to be over twice as high among people living in the most deprived regions of Germany compared with people living in the least deprived regions (men: 2.41, 95% CI 1.27 to 4.28; women: 2.40, 95% CI 1.25 to 4.29). The strength of the association increased with increasing age until the age of 75 years. No sex differences were present.
Conclusions:
The study adds new evidence regarding the association between type 2 diabetes incidence and regional deprivation for Germany. The results underpin the importance to intensify public health actions to reduce social inequalities in Germany and whole Europe in the future.
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