Maier Werner, Scheidt-Nave Christa, Holle Rolf, Kroll Lars E, Lampert Thomas, Du Yong, Heidemann Christin, Mielck Andreas
Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany.
Robert Koch Institute, Berlin, Germany.
PLoS One. 2014 Feb 27;9(2):e89661. doi: 10.1371/journal.pone.0089661. eCollection 2014.
There is increasing evidence that prevention programmes for type 2 diabetes mellitus (T2DM) and obesity need to consider individual and regional risk factors. Our objective is to assess the independent association of area level deprivation with T2DM and obesity controlling for individual risk factors in a large study covering the whole of Germany.
We combined data from two consecutive waves of the national health interview survey 'GEDA' conducted by the Robert Koch Institute in 2009 and 2010. Data collection was based on computer-assisted telephone interviews. After exclusion of participants <30 years of age and those with missing responses, we included n=33,690 participants in our analyses. The outcome variables were the 12-month prevalence of known T2DM and the prevalence of obesity (BMI ≥ 30 kg/m(2)). We also controlled for age, sex, BMI, smoking, sport, living with a partner and education. Area level deprivation of the districts was defined by the German Index of Multiple Deprivation. Logistic multilevel regression models were performed using the software SAS 9.2.
Of all men and women living in the most deprived areas, 8.6% had T2DM and 16.9% were obese (least deprived areas: 5.8% for T2DM and 13.7% for obesity). For women, higher area level deprivation and lower educational level were both independently associated with higher T2DM and obesity prevalence [highest area level deprivation: OR 1.28 (95% CI: 1.05-1.55) for T2DM and OR 1.28 (95% CI: 1.10-1.49) for obesity]. For men, a similar association was only found for obesity [OR 1.20 (95% CI: 1.02-1.41)], but not for T2DM.
Area level deprivation is an independent, important determinant of T2DM and obesity prevalence in Germany. Identifying and targeting specific area-based risk factors should be considered an essential public health issue relevant to increasing the effectiveness of diabetes and obesity prevention.
越来越多的证据表明，2型糖尿病（T2DM）和肥胖症的预防计划需要考虑个体和区域风险因素。我们的目的是在一项覆盖全德国的大型研究中，评估区域层面的贫困与T2DM和肥胖症之间的独立关联，并控制个体风险因素。
我们合并了罗伯特·科赫研究所于2009年和2010年进行的两轮全国健康访谈调查“GEDA”的数据。数据收集基于计算机辅助电话访谈。在排除年龄<30岁的参与者和有缺失回答的参与者后，我们纳入了n = 33,690名参与者进行分析。结局变量为已知T2DM的12个月患病率和肥胖症患病率（BMI≥30 kg/m²）。我们还控制了年龄、性别、BMI、吸烟、运动、与伴侣同住情况和教育程度。地区层面的贫困程度由德国多重贫困指数定义。使用SAS 9.2软件进行逻辑多水平回归模型分析。
生活在最贫困地区的所有男性和女性中，8.6%患有T2DM，16.9%肥胖（最不贫困地区：T2DM为5.8%，肥胖症为13.7%）。对于女性，更高的区域层面贫困程度和更低的教育水平均与更高的T2DM和肥胖症患病率独立相关[T2DM：最高区域层面贫困程度的比值比（OR）为1.28（95%置信区间：1.05 - 1.55），肥胖症的OR为1.28（95%置信区间：1.10 - 1.49）]。对于男性，仅在肥胖症方面发现了类似的关联[OR为1.20（95%置信区间：1.02 - 1.41）]，而在T2DM方面未发现。
区域层面的贫困是德国T2DM和肥胖症患病率的一个独立且重要的决定因素。识别并针对特定的基于区域的风险因素应被视为一个与提高糖尿病和肥胖症预防效果相关的重要公共卫生问题。
