Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
BMJ Open Diabetes Res Care. 2019 Dec 17;7(1):e000857. doi: 10.1136/bmjdrc-2019-000857. eCollection 2019.
The aim of this analysis was to estimate the association between regional deprivation and type 2 diabetes incidence and to investigate differences by age and sex for Germany.
Type 2 diabetes incidence rate ratios comparing the most deprived fifth of the population to the remainder of the population (divided into quintiles) were estimated using the illness-death model, which describes the relationship between prevalence, mortality, and incidence. For the analysis, we used the type 2 diabetes prevalence and the general mortality rate according to deprivation quintiles, which we calculated based on valid estimates for Germany. Because mortality rate ratios for people with type 2 diabetes compared with people without type 2 diabetes are lacking for Germany, we used estimates from Scotland. Estimates were standardized to the German population in 2012 and stratified by sex.
Incidence of type 2 diabetes was estimated to be over twice as high among people living in the most deprived regions of Germany compared with people living in the least deprived regions (men: 2.41, 95% CI 1.27 to 4.28; women: 2.40, 95% CI 1.25 to 4.29). The strength of the association increased with increasing age until the age of 75 years. No sex differences were present.
The study adds new evidence regarding the association between type 2 diabetes incidence and regional deprivation for Germany. The results underpin the importance to intensify public health actions to reduce social inequalities in Germany and whole Europe in the future.
本分析旨在评估德国地区贫困与 2 型糖尿病发病率之间的关系，并探讨年龄和性别差异。
使用疾病死亡模型估计 2 型糖尿病发病率比率，将最贫困的五分之一人口与其余人口（分为五分位数）进行比较。该模型描述了患病率、死亡率和发病率之间的关系。为了进行分析，我们使用了根据贫困五分位数计算的 2 型糖尿病患病率和一般死亡率，这些数据是根据德国的有效估计值计算得出的。由于德国缺乏 2 型糖尿病患者与非 2 型糖尿病患者的死亡率比率，我们使用了苏格兰的估计值。估计值按照德国 2012 年的人口进行了标准化，并按性别分层。
与生活在贫困程度最低地区的人相比，德国最贫困地区的人患 2 型糖尿病的发病率估计要高出两倍多（男性：2.41，95%CI1.27 至 4.28；女性：2.40，95%CI1.25 至 4.29）。这种关联的强度随着年龄的增长而增加，直到 75 岁。不存在性别差异。
本研究为德国 2 型糖尿病发病率与地区贫困之间的关系提供了新的证据。研究结果强调了未来在德国和整个欧洲加强公共卫生行动以减少社会不平等的重要性。
