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Lower educational level is a predictor of incident type 2 diabetes in European countries: The EPIC-InterAct study.

Sacerdote, Carlotta; Ricceri, Fulvio; Rolandsson, Olov; Baldi, Ileana; Chirlaque, Maria-Dolores; Feskens, Edith; Bendinelli, Benedetta; Ardanaz, Eva; Arriola, Larraitz and Balkau, Beverley, et al. (2012) In International Journal of Epidemiology 41(4). p.1162-1173
Abstract
BACKGROUND:

Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide. In high-income countries, low socioeconomic status seems to be related to a high incidence of T2DM, but very little is known about the intermediate factors of this relationship.



METHOD:

We performed a case-cohort study in eight Western European countries nested in the EPIC study (n = 340 234, 3.99 million person-years of follow-up). A random sub-cohort of 16 835 individuals and a total of 12 403 incident cases of T2DM were identified. Crude and multivariate-adjusted hazard ratios (HR) were estimated for each country and pooled across countries using meta-analytical methods. Age-, gender- and... (More)
BACKGROUND:

Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide. In high-income countries, low socioeconomic status seems to be related to a high incidence of T2DM, but very little is known about the intermediate factors of this relationship.



METHOD:

We performed a case-cohort study in eight Western European countries nested in the EPIC study (n = 340 234, 3.99 million person-years of follow-up). A random sub-cohort of 16 835 individuals and a total of 12 403 incident cases of T2DM were identified. Crude and multivariate-adjusted hazard ratios (HR) were estimated for each country and pooled across countries using meta-analytical methods. Age-, gender- and country-specific relative indices of inequality (RII) were used as the measure of educational level and RII tertiles were analysed.



RESULTS:

Compared with participants with a high educational level (RII tertile 1), participants with a low educational level (RII tertile 3) had a higher risk of T2DM [HR: 1.77, 95% confidence interval (CI): 1.69-1.85; P-trend < 0.01]. The HRs adjusted for physical activity, smoking status and propensity score according to macronutrient intake were very similar to the crude HR (adjusted HR: 1.67, 95% CI: 1.52-1.83 in men; HR: 1.88, 95% CI: 1.73-2.05 in women). The HRs were attenuated only when they were further adjusted for BMI (BMI-adjusted HR: 1.36, 95% CI: 1.23-1.51 in men; HR: 1.32, 95% CI: 1.20-1.45 in women).



CONCLUSION:

This study demonstrates the inequalities in the risk of T2DM in Western European countries, with an inverse relationship between educational level and risk of T2DM that is only partially explained by variations in BMI. (Less)
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organization
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type
Contribution to journal
publication status
published
subject
in
International Journal of Epidemiology
volume
41
issue
4
pages
1162 - 1173
publisher
Oxford University Press
external identifiers
  • wos:000308232200035
  • pmid:22736421
  • scopus:84865703223
ISSN
1464-3685
DOI
10.1093/ije/dys091
language
English
LU publication?
yes
id
4d33162d-6c79-421a-965e-f0df49ca1609 (old id 2858947)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22736421?dopt=Abstract
date added to LUP
2012-07-04 19:56:44
date last changed
2017-10-01 04:58:12
@article{4d33162d-6c79-421a-965e-f0df49ca1609,
  abstract     = {BACKGROUND: <br/><br>
Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide. In high-income countries, low socioeconomic status seems to be related to a high incidence of T2DM, but very little is known about the intermediate factors of this relationship.<br/><br>
<br/><br>
METHOD: <br/><br>
We performed a case-cohort study in eight Western European countries nested in the EPIC study (n = 340 234, 3.99 million person-years of follow-up). A random sub-cohort of 16 835 individuals and a total of 12 403 incident cases of T2DM were identified. Crude and multivariate-adjusted hazard ratios (HR) were estimated for each country and pooled across countries using meta-analytical methods. Age-, gender- and country-specific relative indices of inequality (RII) were used as the measure of educational level and RII tertiles were analysed. <br/><br>
<br/><br>
RESULTS: <br/><br>
Compared with participants with a high educational level (RII tertile 1), participants with a low educational level (RII tertile 3) had a higher risk of T2DM [HR: 1.77, 95% confidence interval (CI): 1.69-1.85; P-trend &lt; 0.01]. The HRs adjusted for physical activity, smoking status and propensity score according to macronutrient intake were very similar to the crude HR (adjusted HR: 1.67, 95% CI: 1.52-1.83 in men; HR: 1.88, 95% CI: 1.73-2.05 in women). The HRs were attenuated only when they were further adjusted for BMI (BMI-adjusted HR: 1.36, 95% CI: 1.23-1.51 in men; HR: 1.32, 95% CI: 1.20-1.45 in women). <br/><br>
<br/><br>
CONCLUSION: <br/><br>
This study demonstrates the inequalities in the risk of T2DM in Western European countries, with an inverse relationship between educational level and risk of T2DM that is only partially explained by variations in BMI.},
  author       = {Sacerdote, Carlotta and Ricceri, Fulvio and Rolandsson, Olov and Baldi, Ileana and Chirlaque, Maria-Dolores and Feskens, Edith and Bendinelli, Benedetta and Ardanaz, Eva and Arriola, Larraitz and Balkau, Beverley and Bergmann, Manuela and Beulens, Joline Wj and Boeing, Heiner and Clavel-Chapelon, Françoise and Crowe, Francesca and de Lauzon-Guillain, Blandine and Forouhi, Nita and Franks, Paul W and Gallo, Valentina and Gonzalez, Carlos and Halkjær, Jytte and Illner, Anne-Kathrin and Kaaks, Rudolf and Key, Timothy and Khaw, Kay-Tee and Navarro, Carmen and Nilsson, Peter and Dal Ton, Susanne Oksbjerg and Overvad, Kim and Pala, Valeria and Palli, Domenico and Panico, Salvatore and Polidoro, Silvia and Quirós, J Ramón and Romieu, Isabelle and Sánchez, María-José and Slimani, Nadia and Sluijs, Ivonne and Spijkerman, Annemieke and Teucher, Birgit and Tjønneland, Anne and Tumino, Rosario and van der A, Daphne and Vergnaud, Anne-Claire and Wennberg, Patrik and Sharp, Stephen and Langenberg, Claudia and Riboli, Elio and Vineis, Paolo and Wareham, Nicholas},
  issn         = {1464-3685},
  language     = {eng},
  number       = {4},
  pages        = {1162--1173},
  publisher    = {Oxford University Press},
  series       = {International Journal of Epidemiology},
  title        = {Lower educational level is a predictor of incident type 2 diabetes in European countries: The EPIC-InterAct study.},
  url          = {http://dx.doi.org/10.1093/ije/dys091},
  volume       = {41},
  year         = {2012},
}