Association of neighbourhood unemployment rate with incident Type 2 diabetes mellitus in five German regions

The role of neighborhood inequalities on diabetes prevention care: a mini-review

An emerging research niche has focused on the link between social determinants of health and diabetes mellitus, one of the most prevalent non-communicable diseases in modern society. The aim of the present mini-review is to explore and summarize current findings in this field targeting high-income countries. In the presence of disadvantaged neighborhood factors (including socioeconomic status, food environment, walkability and neighborhood aesthetics), diabetes prevention and care are affected at a multidimensional level. The vast majority of the included studies suggest that, besides individual risk factors, aggregated neighborhood inequalities should be tackled to implement effective evidence-based policies for diabetes mellitus.

Association between sepsis incidence and regional socioeconomic deprivation and health care capacity in Germany - an ecological study

Background

Sepsis is a substantial health care burden. Data on regional variation in sepsis incidence in Germany and any possible associations with regional socioeconomic deprivation and health care capacity is lacking.

Methods

Ecological study based on the nationwide hospital Diagnosis-related Groups (DRG) statistics data of 2016. We identified sepsis by ICD-10-codes and calculated crude and age-standardized incidence proportions in the 401 administrative German districts. Associations between socioeconomic and health care capacity indicators and crude and age-adjusted sepsis incidence were investigated by simple and multiple negative binomial (NB) regressions.

Results

In 2016, sepsis incidence was 178 per 100,000 inhabitants and varied 10-fold between districts. We found that the rate of students leaving school without certificate was significantly associated with crude and age-standardized explicit sepsis incidence in the simple and multiple NB regressions. While we observed no evidence for an association to the capacity of hospital beds and general practitioners, the distance to the nearest pharmacy was associated with crude- and age-standardized sepsis incidence. In the multiple regression analyses, an increase of the mean distance + 1000 m was associated with an expected increase by 21.6 [95% CI, 10.1, 33.0] (p < 0.001), and 11.1 [95% CI, 1.0, 21.2]/100,000 population (p = .026) after adjusting for age differences between districts.

Conclusions

Residence in districts with lower socioeconomic status (e.g., less education) and further distance to pharmacies are both associated with an increased sepsis incidence. This warrants further research with individual-level patient data to better model and understand such dependencies and to ultimately design public health interventions to address the burden of sepsis in Germany.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11629-4.

The Impact of Stressful Life Events on the Incidence of Type 2 Diabetes in U.S. Adults From the Health and Retirement Study

OBJECTIVES

We evaluated the association between cumulative stressful life events (SLE) and type of stress (lifetime vs recent) and incident diabetes (Type 2 diabetes mellitus [T2DM]) in middle-aged U.S. adults.

METHODS

Data from the 2006-2014 waves of the Health and Retirement Study (HRS) were analyzed (n = 7,956). Stress-related differences in age at T2DM diagnosis were estimated using Cox proportional hazards models.

RESULTS

The adjusted risk of T2DM significantly increased by 6% per unit increase in cumulative SLE (95% confidence interval [CI] = 1.03, 1.11), by 5% per unit increase in lifetime stress (95% CI = 1.00, 1.09), and by 23% per unit increase in recent stress (95% CI = 1.12, 1.36). Each level of cumulative SLE (1, 2, 3, and ≥4 events) and recent stress (1 and ≥2 events) compared to no stress was significantly associated with an increased risk of T2DM. Each level of lifetime stress compared to no stress was significantly associated with an elevated risk of T2DM except for 3 events.

DISCUSSION

Cumulative SLE and type of stress were associated with incident T2DM in middle-aged adults. Reducing the direct effect of stress with management interventions may reduce the indirect effect of developing T2DM and warrants further investigation.

The Contextual Effect of Area-Level Unemployment Rate on Lower Back Pain: A Multilevel Analysis of Three Consecutive Surveys of 962,586 Workers in Japan

This study examined the associations between area-level unemployment rates and lower back pain using large-scale data provided by the Japanese working population. We analyzed data from a nationally representative, repeated, cross-sectional study across three waves from 2010, 2013, and 2016 in 47 Japanese subnational level areas. Workers aged 18-64 years (n = 962,586) were eligible to participate in the study. A multilevel logistic model was used to examine the association between the unemployment rate and lower back pain. The self-report of lower back pain was a dependent variable. The prefecture-level unemployment rate was analyzed as an independent variable, adjusted for individual-level covariates (e.g., gender, age, socioeconomic status). After adjusting for all covariates, the main effect of the prefecture-level unemployment rate was statistically significant: the odds ratio (OR) (95% credible interval (CrI)) was 1.01 (1.002, 1.03). Additionally, the OR (95% CrI) for the interaction between gender and the prefecture-level unemployment rate was 1.02 (1.01, 1.03) indicating that women were more affected by area-level employment status than men. In conclusion, a significant association between the unemployment rate and lower back pain was observed in the Japanese working population. Women were more sensitive to the unemployment rate.

Associations between stressful life events and diabetes: Findings from the China Kadoorie Biobank study of 500,000 adults

AIMS/INTRODUCTION

Evidence has shown that stressful life events are associated with the development of diabetes, yet studies in mainland China are scarce. In the present study, we explored the associations between cumulative and specific stressful life events and the prevalence of diabetes in Chinese adults.

MATERIALS AND METHODS

The cross-sectional data were from the China Kadoorie Biobank study, which enrolled approximately 500,000 adults aged 30-79 years from 10 diverse regions of China. Logistic regression models were used to calculate the adjusted odds ratio (OR) and the 95% confidence interval (CI).

RESULTS

Of the 473,607 participants, 25,301 (5.34%) had type 2 diabetes (2.68% clinically-identified and 2.66% screen-detected). Participants who experienced one and two or more stressful life events were 1.10-fold (OR 1.10, 95% CI 1.05-1.16) and 1.33-fold (OR 1.33, 95% CI 1.13-1.57) more likely to have type 2 diabetes. Three categories of work-related events (OR 1.15, 95% CI 1.01-1.31), as well as family-related events (OR 1.11, 95% CI 1.06-1.18) and personal-related events (OR 1.18, 95% CI 1.03-1.36), were associated with an increased likelihood of type 2 diabetes. Regarding the specific life events, the ORs of loss of job or retirement, as well as major conflict within family, death or major illness of other close family member and major injury or traffic accident, were 1.24 (95% CI 1.02-1.52), 1.24 (95% CI 1.08-1.43), 1.13 (95% CI 1.06-1.20) and 1.20 (95% CI 1.01-1.43), respectively.

CONCLUSIONS

The present study showed that cumulative and specific stressful life events were significantly associated with an increased prevalence of diabetes.

Individual and area-level determinants associated with C-reactive protein as a marker of cardiometabolic risk among adults: Results from the German National Health Interview and Examination Survey 2008-2011

BACKGROUND

High-sensitivity C-reactive protein (hsCRP) is a sensitive biomarker of systemic inflammation and is related to the development and progression of cardiometabolic diseases. Beyond individual-level determinants, characteristics of the residential physical and social environment are increasingly recognized as contextual determinants of systemic inflammation and cardiometabolic risks. Based on a large nationwide sample of adults in Germany, we analyzed the cross-sectional association of hsCRP with residential environment characteristics. We specifically asked whether these associations are observed independent of determinants at the individual level.

METHODS

Data on serum hsCRP levels and individual sociodemographic, behavioral, and anthropometric characteristics were available from the German Health Interview and Examination Survey for Adults (2008-2011). Area-level variables included, firstly, the predefined German Index of Socioeconomic Deprivation (GISD) derived from the INKAR (indicators and maps on spatial and urban development in Germany and Europe) database and, secondly, population-weighted annual average concentration of particulate matter (PM10) in ambient air provided by the German Environment Agency. Associations with log-transformed hsCRP levels were analyzed using random-intercept multi-level linear regression models including 6,768 participants aged 18-79 years nested in 162 municipalities.

RESULTS

No statistically significant association of PM10 exposure with hsCRP was observed. However, adults residing in municipalities with high compared to those with low social deprivation showed significantly elevated hsCRP levels (change in geometric mean 13.5%, 95%CI 3.2%-24.7%) after adjusting for age and sex. The observed relationship was independent of individual-level educational status. Further adjustment for smoking, sports activity, and abdominal obesity appeared to markedly reduce the association between area-level social deprivation and hsCRP, whereas all individual-level variables contributed significantly to the model.

CONCLUSIONS

Area-level social deprivation is associated with higher systemic inflammation and the potentially mediating role of modifiable risk factors needs further elucidation. Identifying and assessing the source-specific harmful components of ambient air pollution in population-based studies remains challenging.

Prevalence of Diabetes Mellitus among Roma Populations-A Systematic Review

Background: The aim of this study was to estimate the prevalence of diabetes mellitus in the Roma population and compare it to the prevalence in the Caucasian population. Methods: Using the words “Roma”, “Gypsies”, “Romani”, and ”traveler” in combination with “diabetes, “metabolic syndrome”, “cardiovascular disease” and “health status” we searched the MEDLINE, Pubmed and Scopus databases for articles in English that focused on the prevalence of diabetes mellitus among Roma populations published until December 2017. Results: Five studies met the inclusion criteria. The results of four of them suggested a higher prevalence of diabetes among Romani compared to Caucasians but none of them reached the standards regarding representative samples and number of cases for a conclusive result. Conclusion: Although some of the existing studies suggest a substantial prevalence of diabetes among Roma populations and even a higher risk of developing diabetes for Roma persons compared to Caucasians, the number of published literature on this topic remains very low and insufficient in design and number of participants to draw any conclusions.

The usefulness of small-area-based socioeconomic characteristics in assessing the treatment outcomes of type 2 diabetes patients: a register-based mixed-effect study

BACKGROUND

Assessment of the differences in the outcomes of care by socioeconomic status (SES) is beneficial for both the efficient targeting of health care services and to decrease health inequalities. This study compares the effects of three patient-based SES predictors (earned income, educational attainment, employment status) with three small-area-based SES predictors (median income, educational attainment, proportion of the unemployed) on the treatment outcomes of type 2 diabetes patients.

METHODS

Mixed-effect modeling was applied to analyse how SES factors affect the treatment outcomes of type 2 diabetes patients. The treatment outcomes were assessed by the patients' latest available glycated hemoglobin A1C (HbA1c) value. We used electronic health records of type 2 diabetes patients from the regional electronic patient database, the patients' individual register-based SES information from Statistics Finland, and the SES information about the population of the postal code area of the patients from Statistics Finland.

RESULTS

The effects of attained education on the treatment outcomes, both at the patient-level and the small-area-level are quite similar. Age and male gender were associated with higher HbA1c values and lower education indicated higher HbA1c values. Unemployment was not associated with HbA1c values at either the patient-level or the area-level. Income gave divergent results: high values of HbA1c were associated with low patient incomes but the median income of the postal code area did not predict the treatment outcomes of patients.

CONCLUSIONS

Our comparative study of three SES factors shows that the effects of attained education on the treatment outcomes are rather similar, regardless of whether patient-based or small-area-based predictors are used. Small-area-based SES variables can be a good way to overcome the absence of individual SES information, but further research is needed to find the valid small-area factors by disease. This possibility of using more small-area-based data would be valuable in health service research and first-hand planning of health care services.

Association of neighbourhood socioeconomic status and diabetes burden using electronic health records in Madrid (Spain): the HeartHealthyHoods study

OBJECTIVE

To study the association between neighbourhood socioeconomic status and diabetes prevalence, incidence, and control in the entire population of northeastern Madrid, Spain.

SETTING

Electronic health records of the primary-care system in four districts of Madrid (Spain).

PARTICIPANTS

269 942 people aged 40 or older, followed from 2013 to 2014.

EXPOSURE

Neighbourhoodsocioeconomic status (NSES), measured using a composite index of seven indicators from four domains of education, wealth, occupation and living conditions.

PRIMARY OUTCOME MEASURES

Diagnosis of diabetes based on ICPC-2 codes and glycated haemoglobin (HbA1c %).

RESULTS

In regression analyses adjusted by age and sex and compared with individuals living in low NSES neighbourhoods, men living in medium and high NSES neighbourhoods had 10% (95% CI: 6% to 15%) and 29% (95% CI: 25% to 32%) lower prevalence of diabetes, while women had 27% (95% CI: 23% to 30%) and 50% (95% CI: 47% to 52%) lower prevalence of diabetes. Moreover, the hazard of diabetes in men living in medium and high NSES neighbourhoods was 13% (95% CI: 1% to 23%) and 20% (95% CI: 9% to 29%) lower, while the hazard of diabetes in women living in medium and high NSES neighbourhoods was 17% (95% CI: 3% to 29%) and 31% (95% CI: 20% to 41%) lower. Individuals living in medium and high SES neighbourhoods had 8% (95% CI: 2% to 15%) and 15% (95% CI: 9% to 21%) lower prevalence of lack of diabetes control, and a decrease in average HbA1c % of 0.05 (95% CI: 0.01 to 0.10) and 0.11 (95% CI: 0.06 to 0.15).

CONCLUSIONS

Diabetes prevalence, incidence and lack of control increased with decreasing NSES in a southern European city. Future studies should provide mechanistic insights and targets for intervention to address this health inequity.

Neighborhood Environments and Diabetes Risk and Control

PURPOSE OF REVIEW

The objective of this review is to highlight the evidence on the association between contextual characteristics of residential environments and type 2 diabetes, to provide an overview of the methodological challenges and to outline potential topics for future research in this field.

RECENT FINDINGS

The link between neighborhood socioeconomic status or deprivation and diabetes prevalence, incidence, and control is robust and has been replicated in numerous settings, including in experimental and quasi-experimental studies. The association between characteristics of the built environment that affect physical activity, other aspects of the built environment, and diabetes risk is robust. There is also evidence for an association between food environments and diabetes risk, but some conflicting results have emerged in this area. While the evidence base on the association of neighborhood socioeconomic status and built and physical environments and diabetes is large and robust, challenges remain related to confounding due to neighborhood selection. Moreover, we also outline five paths forward for future research on the role of neighborhood environments on diabetes.

Does contextual unemployment matter for health status across the life course? A longitudinal multilevel study exploring the link between neighbourhood unemployment and functional somatic symptoms

This study examines whether neighbourhood unemployment is related to functional somatic symptoms, independently of the individual employment, across the life course and at four specific life course periods (age 16, 21, 30 and 42). Self-reported questioner data was used from a 26-year prospective Swedish cohort (n=1010) with complementary neighbourhood register data. A longitudinal and a set of age-specific cross-sectional hierarchal linear regressions was carried out. The results suggest that living in a neighbourhood with high unemployment has implications for residents' level of functional somatic symptoms, regardless of their own unemployment across time, particularly at age 30.