Explanations of Socioeconomic Differences in Excess Risk of Type 2 Diabetes in Swedish Men and Women

Abstract

OBJECTIVE -We investigated to what extent socioeconomic differences in type 2 diabetes risk could be explained by established risk factors (obesity, physical inactivity, smoking, and heredity) and psychosocial factors (low decision latitude at work and low sense of coherence). RESEARCH DESIGN AND METHODS-This cross-sectional study comprised 3,128 healthy Swedish men and 4,821 women, aged 35-56 years, living in the Stockholm area. An oral glucose tolerance test identified 55 men and 52 women with type 2 diabetes. The relative contribution of established and psychosocial factors to socioeconomic differences in diabetes risk was assessed by comparing analyses with adjustment for different sets of these factors.RESULTS -The relative risks (RRs) for type 2 diabetes in middle and low socioeconomic groups in men were 2.4 (95% CI 1.0 -5.3) and 2.9 (1.5-5.7), respectively, and in women 3.2 (1.5-6.6) and 2.7 (1.3-5.9), respectively. In men, the RRs decreased to 1.9 (0.8 -4.4) and 2.1 (1.0 -4.2) after adjustment for established risk factors; no further change was found when psychosocial factors were included. In women, the RRs changed to 2.4 (1.1-5.2) and 1.6 (0.7-3.8) by including established risk factors and to 2.3 (1.0 -5.1) and 1.9 (0.8 -4.3) by inclusion of psychosocial factors. After adjustment for both established and psychosocial factors, the RRs were 1.4 (0.6 -3.6) and 1.0 (0.4 -2.5), respectively.CONCLUSIONS -In men, the excess risk of type 2 diabetes was partly explained by established risk factors (36 -42%), whereas psychosocial factors had no effect. In women, most of the socioeconomic differences in type 2 diabetes were explained by simultaneous adjustment for established risk factors and psychosocial factors (81-100%).

Life-Course Socioeconomic Position and Type 2 Diabetes Mellitus

“…Similarly, the results of prospective (7,10,(12)(13)(14)(15) and cross-sectional (16)(17)(18)(19)(20) studies typically have shown inverse associations between adult SEP (measured as educational level, occupation, and income) and T2D. There is some indication that this association may be sex-specific.…”

Stress and Diabetes: A Review of the Links

“…Agardh et al 30 demonstrated that work stress, as indicated by low decision latitude (or fewer opportunities for decision making), along with a low sense of coherence, significantly increased risk for type 2 diabetes. Low sense of coherence is thought to negatively affect people's ability to cope with stressors 31 and also to be linked to unhealthy lifestyle patterns that could lead to poor health.…”

The perspectives of Brazilian homemakers concerning living with type 2 diabetes mellitus

“…Studies comparing men and women with DM2 report that women have worse glycemic control, self-care practices, and quality of life (1)(2) . Factors associated with these findings reflect the growing recognition that there are different health and illness patterns between men and women, which transcend biology and include psychological, cultural, political, economic, and historical factors (3)(4)(5) .…”