Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Diabetologia. 2021 Dec;64(12):2762-2772. doi: 10.1007/s00125-021-05559-4. Epub 2021 Sep 13.
AIMS/HYPOTHESIS: High prevalence of coexisting morbidity in people with type 2 diabetes highlights the need to include interactions with education and comorbidity in the assessments of societal consequences of type 2 diabetes. The purpose of this study was to estimate the joint effects of education, type 2 diabetes and six frequent comorbidities.
Nationwide administrative register data on type 2 diabetes diagnosis, hospital admissions, education and disability pension were grouped at the individual level by means of a unique personal identification number. Included were all people (N = 2,281,599) in the age span of 40-59 years living in Denmark in the period 2005 to 2017, covering a total of 17,754,788 person-years. We used both Cox proportional hazards and Aalen additive hazards models to estimate relative and absolute joint effects of type 2 diabetes, educational attainment and six common comorbidities (CVD, cancer and cerebrovascular, respiratory, musculoskeletal and psychiatric diseases). We decomposed the joint effects of educational level, type 2 diabetes and comorbidities into main effects and the interaction effect, measured as extra cases of disability pension.
Lower level of educational attainment, type 2 diabetes and comorbidities independently contributed to additional granted disability pensions. The joint number of cases of disability pension exceeded the sum of the three exposures, which is explained by a synergistic effect of lower educational level, type 2 diabetes and comorbidity.
CONCLUSIONS/INTERPRETATION: In this population study, the joint effects of type 2 diabetes, lower education and comorbidity were associated with larger than additive rates of disability pension. An integrated approach that takes into account socioeconomic barriers to type 2 diabetes rehabilitation may slow down disease progression and increase the working ability of socially disadvantaged people.
目的/假设：2 型糖尿病患者共存发病率高，突出表明需要将教育和合并症与 2 型糖尿病的社会后果评估相结合。本研究旨在估计教育、2 型糖尿病和六种常见合并症的联合作用。
通过使用独特的个人识别号码，将 2 型糖尿病诊断、住院、教育和残疾抚恤金的全国性行政登记数据在个人层面上进行分组。包括所有（N=2,281,599）年龄在 40-59 岁之间居住在丹麦的人，涵盖了 2005 年至 2017 年期间的 17,754,788 人年。我们使用 Cox 比例风险和 Aalen 加法风险模型来估计 2 型糖尿病、教育程度和六种常见合并症（心血管疾病、癌症和脑血管、呼吸系统、肌肉骨骼和精神疾病）的相对和绝对联合作用。我们将教育水平、2 型糖尿病和合并症的联合作用分解为主要作用和相互作用，以残疾抚恤金的额外病例来衡量。
较低的教育程度、2 型糖尿病和合并症独立导致额外的残疾抚恤金。残疾抚恤金的联合病例数超过了三个暴露因素的总和，这是由于较低的教育程度、2 型糖尿病和合并症之间的协同作用所致。
结论/解释：在这项人群研究中，2 型糖尿病、较低教育程度和合并症的联合作用与残疾抚恤金的加性率呈正相关。采取综合方法，考虑到 2 型糖尿病康复的社会经济障碍，可能会减缓疾病进展，提高社会劣势人群的工作能力。
