Attenuating the mortality risk of socioeconomic deprivation in type 2 diabetes: Minimum and compensatory physical...

Type 2 diabetes mellitus (T2DM) is associated with increased mortality, which may be exacerbated by socioeconomic deprivation. Whether objectively measured moderate-to-vigorous physical activity (MVPA) can attenuate deprivation-related excess mortality remains unclear.

We analyzed 1,793 UK Biobank participants with prevalent T2DM and valid wrist-worn accelerometer data. Socioeconomic deprivation was assessed using the Townsend Deprivation Index (TDI). Associations of TDI and MVPA with all-cause mortality were examined using multivariable Cox models, restricted cubic splines, Kneedle-derived threshold detection, and compensation-point estimation.

Higher deprivation and lower MVPA were jointly associated with greater mortality. Compared with high TDI and MVPA < 150 min/week, low TDI and MVPA ≥ 150 min/week showed the greatest adjusted mortality reduction (HR 0.423, 95% CI 0.286-0.625). MVPA exhibited a nonlinear inverse association with mortality, with an overall elbow at 72 min/week and plateau at 131 min/week. Stratified thresholds showed elbows at 68 min/week (plateau 126 min/week) for Low TDI and 76 min/week (plateau 134 min/week) for High TDI. The compensation point for high-deprivation individuals was 31 min/week.

Achievable MVPA levels may attenuate deprivation-related excess mortality in T2DM. Quantifying MVPA levels provides a novel, equity-oriented basis for targeted exercise recommendations.