Safieddine Batoul, Geyer Siegfried, Sperlich Stefanie, Grasshoff Julia, Beller Johannes
Medical Sociology Unit, Hannover Medical School, OE 5420 Carl-Neuberg-Street 1, 30625, Hannover, Germany.
Sci Rep. 2025 Mar 26;15(1):10390. doi: 10.1038/s41598-025-95326-x.
Early onset type 2 diabetes (T2D) is increasingly recognized as a significant public health concern, leading to more severe complications and a greater decline in quality of life compared to T2D diagnosed later in life. This can have a profound impact on the workforce. Social status-whether assessed vertically through levels of income, education or job position or horizontally through occupational groups-can play a critical role in the risk of developing early onset T2D. While research focusing on vertical socioeconomic inequalities related to T2D is abundant, there is currently no study that combines both vertical and horizontal perspectives to explore vulnerable groups. We aim to combine the vertical and horizontal approaches to examine vulnerable groups within the employed population regarding early onset T2D. Using data from the largest statutory health insurance provider in the state of lower Saxony, Germany for the year 2019 "Allgemeine Ortskrankenkasse Niedersachsen" (AOKN), we examined education and income inequalities in early onset T2D among nine occupational sectors using logistic regression analyses (N = 365059). Age and gender adjusted prevalence rates as illustrated by predicted probabilities were displayed to compare rates of early onset T2D among different education and income levels and occupational groups. Regression tree analysis was used to examine intersectionality between the vertical (levels of income and education) and the horizontal (occupational sector) dimensions in order to determine the most vulnerable groups. Both vertical and horizontal inequalities in early onset T2D exist within the employed population. On the one hand, disparities in education and income were present across various occupational sectors. On the other hand, significant differences in T2D prevalence could be observed within the same education and income levels across different sectors. Notably, affiliation to occupational sector was the primary factor influencing vulnerability to early onset T2D, followed by educational attainment. Individuals with low education working in the "Transport, logistics, protection and security" and "Health, social work, teaching, and education" sectors were among the most vulnerable. It is important to simultaneously examine both vertical and horizontal dimensions of inequalities to identify vulnerable groups within the workforce. Future research should adopt this approach while also exploring other populations and health outcomes.
早发型2型糖尿病（T2D）日益被视为一个重大的公共卫生问题，与晚发型T2D相比，它会导致更严重的并发症和生活质量更大幅度的下降。这可能会对劳动力产生深远影响。社会地位——无论是通过收入、教育水平或职位进行纵向评估，还是通过职业群体进行横向评估——在早发型T2D的发病风险中都可能发挥关键作用。虽然关于与T2D相关的纵向社会经济不平等的研究很多，但目前尚无研究将纵向和横向视角结合起来以探索弱势群体。我们旨在结合纵向和横向方法，研究就业人群中早发型T2D的弱势群体。利用德国下萨克森州最大的法定健康保险提供商2019年的数据“下萨克森州地方医疗保险”（AOKN），我们使用逻辑回归分析（N = 365059）研究了九个职业部门中早发型T2D的教育和收入不平等情况。展示了经年龄和性别调整后的患病率（以预测概率表示），以比较不同教育和收入水平以及职业群体中早发型T2D的患病率。使用回归树分析来研究纵向（收入和教育水平）和横向（职业部门）维度之间的交叉性，以确定最脆弱的群体。就业人群中早发型T2D存在纵向和横向不平等。一方面，不同职业部门存在教育和收入差距。另一方面，在不同部门相同的教育和收入水平内，T2D患病率也存在显著差异。值得注意的是，职业部门归属是影响早发型T2D易感性的主要因素，其次是教育程度。在“运输、物流、保护和安保”以及“健康、社会工作、教学和教育”部门工作的低学历个体是最脆弱的群体之一。同时研究不平等的纵向和横向维度对于识别劳动力中的弱势群体很重要。未来的研究应采用这种方法，同时还应探索其他人群和健康结果。
