Albers Jeroen D, Koster Annemarie, Sezer Bengisu, Meisters Rachelle, Chan Jeffrey A, Wesselius Anke, Schram Miranda T, de Galan Bastiaan E, Lakerveld Jeroen, Bosma Hans
Department of Social Medicine, Maastricht University, Maastricht, The Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
Department of Social Medicine, Maastricht University, Maastricht, The Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
Soc Sci Med. 2025 Jul;376:118046. doi: 10.1016/j.socscimed.2025.118046. Epub 2025 Apr 15.
The relationship between socioeconomic position and type 2 diabetes is well-established; individuals of lower socioeconomic position experience substantially higher rates of the disease. This study investigated the mediating role of perceived and ecometric area-level social cohesion in the association between socioeconomic position and incident type 2 diabetes. In a prospective population-based cohort, The Maastricht Study, we analyzed data from 6,604 participants (age¯ = 58.6 years, 55% female) with a median follow-up of 8.1 (IQR 5.1-10.1) years. We examined whether perceived or area-level social cohesion (in 500 m squares, five-character postal code areas, and neighborhood areas) mediated the association between socioeconomic position (represented by educational attainment, occupational status, or income) and incident type 2 diabetes. We employed a causal mediation approach based on linear regression and Cox proportional hazards models. Individuals with lower socioeconomic position were more likely to perceive lower social cohesion and to live in areas with diminished social cohesion. Lower area-level social cohesion was associated with an increased risk of developing type 2 diabetes. The mediating effect of social cohesion was more pronounced in urban areas. In urban areas, the total effect of education (contrasting the 83rd and 17th percentiles) on type 2 diabetes incidence was a hazard ratio (HR) of 2.03 (95% CI: 1.62-2.58), with area-level social cohesion mediating 24.4% (11.1%-40.3%) of this effect. In less urban areas, social cohesion mediated 12.6% (5.2%-23.0%) of a HR of 1.89 (1.50-2.40). Similar findings were observed with occupational status and income, and across other aggregation levels. Socioeconomic position is linked to lower social cohesion, which is associated with an increased risk of type 2 diabetes. Enhancing social cohesion in disadvantaged areas may help reduce diabetes-related health disparities, particularly in urban settings. Further research is needed to better understand the mechanisms underlying these relationships.
社会经济地位与2型糖尿病之间的关系已得到充分证实；社会经济地位较低的个体患该疾病的几率要高得多。本研究调查了感知到的和生态计量区域层面的社会凝聚力在社会经济地位与2型糖尿病发病之间的关联中所起的中介作用。在一项基于人群的前瞻性队列研究——马斯特里赫特研究中，我们分析了6604名参与者（平均年龄 = 58.6岁，55%为女性）的数据，中位随访时间为8.1年（四分位间距5.1 - 10.1年）。我们研究了感知到的或区域层面的社会凝聚力（在500平方米街区、五位邮政编码区域和邻里区域）是否介导了社会经济地位（以教育程度、职业地位或收入表示）与2型糖尿病发病之间的关联。我们采用了基于线性回归和Cox比例风险模型的因果中介方法。社会经济地位较低的个体更有可能感知到较低的社会凝聚力，并且生活在社会凝聚力较弱的地区。较低的区域层面社会凝聚力与患2型糖尿病风险的增加相关。社会凝聚力的中介作用在城市地区更为明显。在城市地区，教育（对比第83百分位数和第17百分位数）对2型糖尿病发病率的总体效应是风险比（HR）为2.03（95%置信区间：1.62 - 2.58），其中区域层面的社会凝聚力介导了这一效应的24.4%（11.1% - 40.3%）。在城市化程度较低的地区，社会凝聚力介导了风险比为1.89（1.50 - 2.40）的效应的12.6%（5.2% - 23.0%）。在职业地位和收入方面以及在其他聚集水平上也观察到了类似的结果。社会经济地位与较低的社会凝聚力相关联，而较低的社会凝聚力又与2型糖尿病风险的增加相关。增强弱势地区的社会凝聚力可能有助于减少与糖尿病相关的健康差距，尤其是在城市环境中。需要进一步研究以更好地理解这些关系背后的机制。
