Müller G, Wellmann J, Hartwig S, Greiser K H, Moebus S, Jöckel K-H, Schipf S, Völzke H, Maier W, Meisinger C, Tamayo T, Rathmann W, Berger K
Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany.
Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
Diabet Med. 2015 Aug;32(8):1017-22. doi: 10.1111/dme.12652. Epub 2014 Dec 30.
To analyse the association of neighbourhood unemployment with incident self-reported physician-diagnosed Type 2 diabetes in a population aged 45-74 years from five German regions.
Study participants were linked via their addresses at baseline to particular neighbourhoods. Individual-level data from five population-based studies were pooled and combined with contextual data on neighbourhood unemployment. Type 2 diabetes was assessed according to a self-reported physician diagnosis of diabetes. We estimated proportional hazard models (Weibull distribution) in order to obtain hazard ratios and 95% CIs of Type 2 diabetes mellitus, taking into account interval-censoring and clustering.
We included 7250 participants residing in 228 inner city neighbourhoods in five German regions in our analysis. The incidence rate was 12.6 per 1000 person-years (95% CI 11.4-13.8). The risk of Type 2 diabetes mellitus was higher in men [hazard ratio 1.79 (95% CI 1.47-2.18)] than in women and higher in people with a low education level [hazard ratio 1.55 (95% CI 1.18-2.02)] than in those with a high education level. Independently of individual-level characteristics, we found a higher risk of Type 2 diabetes mellitus in neighbourhoods with high levels of unemployment [quintile 5; hazard ratio 1.72 (95% CI 1.23-2.42)] than in neighbourhoods with low unemployment (quintile 1).
Low education level and high neighbourhood unemployment were independently associated with an elevated risk of Type 2 diabetes mellitus. Studies examining the impact of the residential environment on Type 2 diabetes mellitus will provide knowledge that is essential for the identification of high-risk populations.
分析德国五个地区45至74岁人群中社区失业率与自我报告的医生诊断2型糖尿病发病之间的关联。
研究参与者在基线时通过其住址与特定社区建立联系。汇总了五项基于人群研究的个体水平数据，并与社区失业率的背景数据相结合。根据自我报告的医生糖尿病诊断评估2型糖尿病。我们估计了比例风险模型（威布尔分布），以获得2型糖尿病的风险比和95%置信区间，同时考虑到区间删失和聚类情况。
我们的分析纳入了居住在德国五个地区228个市中心社区的7250名参与者。发病率为每1000人年12.6例（95%置信区间11.4 - 13.8）。2型糖尿病的风险在男性中[风险比1.79（95%置信区间1.47 - 2.18）]高于女性，在低教育水平人群中[风险比1.55（95%置信区间1.18 - 2.02）]高于高教育水平人群。独立于个体水平特征，我们发现高失业率社区[五分位数5；风险比1.72（95%置信区间1.23 - 2.42）]中2型糖尿病的风险高于低失业率社区（五分位数1）。
低教育水平和高社区失业率与2型糖尿病风险升高独立相关。研究居住环境对2型糖尿病的影响将为识别高危人群提供至关重要的知识。
