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BMC Public Health
Published in: BMC Public Health 1/2014

Open Access 01-12-2014 | Research article

Area deprivation and the prevalence of type 2 diabetes and obesity: analysis at the municipality level in Germany

Authors: Nina Grundmann, Andreas Mielck, Martin Siegel, Werner Maier

Published in: BMC Public Health | Issue 1/2014

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Abstract

Background

The objective of this study was to analyse the association between area deprivation at municipality level and the prevalence of type 2 diabetes (T2D) and obesity across Germany, controlling for individual socioeconomic status (SES).

Methods

The analyses are based on a large survey conducted in 2006. Information was included from 39,908 adults aged 20 years or above. Area deprivation was assessed using the German Index of Multiple Deprivation (GIMD) at municipality level. About 4,700 municipalities could be included and assigned to a deprivation quintile. Individual SES was assessed by income and educational level. Multilevel logistic models were used to control for individual SES and other potential confounders such as age, sex and physical activity.

Results

We found a positive association of area deprivation with T2D and obesity. Controlling for all individual-level variables, the odds ratios for municipalities in the most deprived quintile were significantly increased for T2D (OR 1.35; 95% CI 1.12–1.64) as well as for obesity (OR 1.14; 95% CI 1.02–1.26). Further analyses showed that these associations were relatively similar for both men and women.

Conclusions

Based on a nationwide dataset, we were able to show that area deprivation at municipality level is significantly associated with the prevalence of T2D and obesity. It will be important to focus preventive efforts on very deprived municipalities.
Literature
1.
Cox M, Boyle PJ, Davey PG, Feng Z, Morris AD: Locality deprivation and Type 2 diabetes incidence: a local test of relative inequalities. Soc Sci Med. 2007, 65: 1953-1964. 10.1016/j.socscimed.2007.05.043.CrossRefPubMed
2.
Connolly V, Unwin N, Sherriff P, Bilous R, Kelly W: Diabetes prevalence and socioeconomic status: a population based study showing increased prevalence of type 2 diabetes mellitus in deprived areas. J Epidemiol Community Health. 2000, 54: 173-177. 10.1136/jech.54.3.173.CrossRefPubMedPubMedCentral
3.
Jackson CA, Jones NR, Walker JJ, Fischbacher CM, Colhoun HM, Leese GP, Lindsay RS, McKnight JA, Morris AD, Petrie JR, Sattar N, Wild SH: Area-based socioeconomic status, type 2 diabetes and cardiovascular mortality in Scotland. Diabetologia. 2012, 55: 2938-2945. 10.1007/s00125-012-2667-1.CrossRefPubMedPubMedCentral
4.
Laraia BA, Karter AJ, Warton EM, Schillinger D, Moffet HH, Adler N: Place matters: neighborhood deprivation and cardiometabolic risk factors in the Diabetes Study of Northern California (DISTANCE). Soc Sci Med. 2012, 74: 1082-1090. 10.1016/j.socscimed.2011.11.036.CrossRefPubMedPubMedCentral
5.
Andersen AF, Carson C, Watt HC, Lawlor DA, Avlund K, Ebrahim S: Life-course socio-economic position, area deprivation and Type 2 diabetes: findings from the British Women’s Heart and Health Study. Diabet Med. 2008, 25: 1462-1468. 10.1111/j.1464-5491.2008.02594.x.CrossRefPubMed
6.
Cox M, Boyle PJ, Davey P, Morris A: Does health-selective migration following diagnosis strengthen the relationship between Type 2 diabetes and deprivation?. Soc Sci Med. 2007, 65: 32-42. 10.1016/j.socscimed.2007.02.045.CrossRefPubMed
7.
Evans JM, Newton RW, Ruta DA, MacDonald TM, Morris AD: Socio-economic status, obesity and prevalence of Type 1 and Type 2 diabetes mellitus. Diabet Med. 2000, 17: 478-480. 10.1046/j.1464-5491.2000.00309.x.CrossRefPubMed
8.
Bocquier A, Cortaredona S, Nauleau S, Jardin M, Verger P: Prevalence of treated diabetes: Geographical variations at the small-area level and their association with area-level characteristics. A multilevel analysis in Southeastern France. Diabetes Metab. 2011, 37: 39-46. 10.1016/j.diabet.2010.07.004.CrossRefPubMed
9.
Larranaga I, Arteagoitia JM, Rodriguez JL, Gonzalez F, Esnaola S, Pinies JA: Socio-economic inequalities in the prevalence of Type 2 diabetes, cardiovascular risk factors and chronic diabetic complications in the Basque Country, Spain. Diabet Med. 2005, 22: 1047-1053. 10.1111/j.1464-5491.2005.01598.x.CrossRefPubMed
10.
Fano V, Pezzotti P, Gnavi R, Bontempi K, Miceli M, Pagnozzi E, Giarrizzo ML, Fortino A: The role of socio-economic factors on prevalence and health outcomes of persons with diabetes in Rome, Italy. Eur J Public Health. 2013, 23: 991-997. 10.1093/eurpub/cks168.CrossRefPubMed
11.
Adams RJ, Howard N, Tucker G, Appleton S, Taylor AW, Chittleborough C, Gill T, Ruffin RE, Wilson DH: Effects of area deprivation on health risks and outcomes: a multilevel, cross-sectional, Australian population study. Int J Public Health. 2009, 54: 183-192. 10.1007/s00038-009-7113-x.CrossRefPubMed
12.
Rathmann W, Haastert B, Icks A, Giani G, Holle R, Meisinger C, Mielck A: Sex differences in the associations of socioeconomic status with undiagnosed diabetes mellitus and impaired glucose tolerance in the elderly population: the KORA Survey 2000. Eur J Public Health. 2005, 15: 627-633. 10.1093/eurpub/cki037.CrossRefPubMed
13.
Schumann B, Kluttig A, Tiller D, Werdan K, Haerting J, Greiser KH: Association of childhood and adult socioeconomic indicators with cardiovascular risk factors and its modification by age: the CARLA Study 2002–2006. BMC Public Health. 2011, 11: 289-10.1186/1471-2458-11-289.CrossRefPubMedPubMedCentral
14.
Maier W, Fairburn J, Mielck A: Regionale Deprivation und Mortalität in Bayern. Entwicklung eines 'Index Multipler Deprivation' auf Gemeindeebene. [Regional deprivation and mortality in Bavaria. Development of a community-based Index of Multiple Deprivation]. Gesundheitswesen. 2012, 74: 416-425.CrossRefPubMed
15.
Maier W, Holle R, Hunger M, Peters A, Meisinger C, Greiser KH, Kluttig A, Völzke H, Schipf S, Moebus S, Bokhof B, Berger K, Mueller G, Rathmann W, Tamayo T, Mielck A: The impact of regional deprivation and individual socio-economic status on the prevalence of Type 2 diabetes in Germany. A pooled analysis of five population-based studies. Diabet Med. 2013, 30: e78-e86. 10.1111/dme.12062.CrossRefPubMed
16.
Maier W, Scheidt-Nave C, Holle R, Kroll LE, Lampert T, Du Y, Heidemann C, Mielck A: Area level deprivation is an independent determinant of prevalent type 2 diabetes and obesity at the national level in Germany. Results from the National Telephone Health Interview Surveys ‘German Health Update’ GEDA 2009 and 2010. PLoS One. 2014, 9: e89661-10.1371/journal.pone.0089661.CrossRefPubMedPubMedCentral
17.
Schuurman N, Bell N, Dunn JR, Oliver L: Deprivation indices, population health and geography: an evaluation of the spatial effectiveness of indices at multiple scales. J Urban Health. 2007, 84: 591-603. 10.1007/s11524-007-9193-3.CrossRefPubMedPubMedCentral
18.
Rathmann W, Scheidt-Nave C, Roden M, Herder C: Type 2 diabetes: Prevalence and relevance of genetic and acquired factors for its prediction. Dtsch Arztebl Int. 2013, 110: 331-337.PubMedPubMedCentral
19.
Duca L, Sippl R, Snell-Bergeon JK: Is the risk and nature of CVD the same in type 1 and type 2 diabetes?. Curr Diab Rep. 2013, 13: 350-361. 10.1007/s11892-013-0380-1.CrossRefPubMed
20.
Perna L, Thien-Seitz U, Ladwig KH, Meisinger C, Mielck A: Socio-economic differences in life expectancy among persons with diabetes mellitus or myocardial infarction: results from the German MONICA/KORA study. BMC Public Health. 2010, 10: 135-10.1186/1471-2458-10-135.CrossRefPubMedPubMedCentral
21.
Potthoff P, Heinemann LA, Guther B: A household panel as a tool for cost-effective health-related population surveys: validity of the ‘Healthcare Access Panel’. Ger Med Sci. 2004, 2: Doc05-PubMedPubMedCentral
22.
Lungen M, Siegel M, Lauterbach KW: Could inequality in health be cured by universal coverage for all citizens?. Int J Clin Pract. 2011, 65: 249-252. 10.1111/j.1742-1241.2010.02487.x.CrossRefPubMed
23.
Siegel M, Luengen M, Stock S: On age-specific variations in income-related inequalities in diabetes, hypertension and obesity. Int J Public Health. 2013, 58: 33-41. 10.1007/s00038-012-0368-7.CrossRefPubMed
24.
Siegel M, Mielck A, Maier W: Individual income, area deprivation, and health: Do income-related health inequalities vary by small area deprivation?. Health Econ. 2014, doi:10.1002/hec.3102. [Epub ahead of print]
25.
Wolfenstetter SB, Menn P, Holle R, Mielck A, Meisinger C, von Lengerke T: Body weight changes and outpatient medical care utilisation: Results of the MONICA/KORA cohorts S3/F3 and S4/F4. Psychosoc Med. 2012, 9: Doc09-PubMedPubMedCentral
26.
Mielck A, Kiess R, von dem Knesebeck O, Stirbu I, Kunst AE: Association between forgone care and household income among the elderly in five Western European countries – analyses based on survey data from the SHARE-study. BMC Health Serv Res. 2009, 9: 52-10.1186/1472-6963-9-52.CrossRefPubMedPubMedCentral
27.
Hu FB: Sedentary lifestyle and risk of obesity and type 2 diabetes. Lipids. 2003, 38: 103-108. 10.1007/s11745-003-1038-4.CrossRefPubMed
28.
Heidemann C, Du Y, Scheidt-Nave C: Diabetes mellitus in Deutschland. Hrsg Robert Koch Institut Berlin. GBE kompakt. 2011, 2 (3): 2-
29.
Noble M, Wright G, Smith G, Dibben C: Measuring multiple deprivation at the small-area level. Environ Plann A. 2006, 38: 169-185. 10.1068/a37168.CrossRef
30.
31.
Koller D, Hoffmann F, Maier W, Tholen K, Windt R, Glaeske G: Variation in antibiotic prescriptions: is area deprivation an explanation? Analysis of 1.2 million children in Germany. Infection. 2013, 41: 121-127. 10.1007/s15010-012-0302-1.CrossRefPubMed
32.
Schäfer T, Pritzkuleit R, Jeszenszky C, Malzahn J, Maier W, Gunther KP, Niethard F: Trends and geographical variation of primary hip and knee joint replacement in Germany. Osteoarthritis Cartilage. 2013, 21: 279-288. 10.1016/j.joca.2012.11.006.CrossRefPubMed
33.
Jansen L, Eberle A, Emrich K, Gondos A, Holleczek B, Kajuter H, Maier W, Nennecke A, Pritzkuleit R, Brenner H: Socio-economic deprivation and cancer survival in Germany: an ecological analysis in 200 districts in Germany. Int J Cancer. 2014, 134: 2951-2960. 10.1002/ijc.28624.CrossRefPubMed
34.
Van Loon AJ, Tijhuis M, Picavet HS, Surtees PG, Ormel J: Survey non-response in the Netherlands: effects on prevalence estimates and associations. Ann Epidemiol. 2003, 13: 105-110. 10.1016/S1047-2797(02)00257-0.CrossRefPubMed
35.
Rathmann W, Haastert B, Icks A, Lowel H, Meisinger C, Holle R, Giani G: High prevalence of undiagnosed diabetes mellitus in Southern Germany: target populations for efficient screening. The KORA survey 2000. Diabetologia. 2003, 46: 182-189.PubMed
36.
37.
38.
Dragano N, Bobak M, Wege N, Peasey A, Verde PE, Kubinova R, Weyers S, Moebus S, Mohlenkamp S, Stang A, Erbel R, Jockel KH, Siegrist J, Pikhart H: Neighbourhood socioeconomic status and cardiovascular risk factors: a multilevel analysis of nine cities in the Czech Republic and Germany. BMC Public Health. 2007, 7: 255-10.1186/1471-2458-7-255.CrossRefPubMedPubMedCentral
39.
van Lenthe FJ, Mackenbach JP: Neighbourhood deprivation and overweight: the GLOBE study. Int J Obes Relat Metab Disord. 2002, 26: 234-240. 10.1038/sj.ijo.0801841.CrossRefPubMed
40.
Cubbin C, Sundquist K, Ahlen H, Johansson SE, Winkleby MA, Sundquist J: Neighborhood deprivation and cardiovascular disease risk factors: protective and harmful effects. Scand J Public Health. 2006, 34: 228-237. 10.1080/14034940500327935.CrossRefPubMed
41.
Verger P, Saliba B, Guagliardo V, Bouhnik AD, Eichenbaum-Voline S: [Individual social characteristics, municipal environment and the prevalence of weight problems in early childhood: a multilevel analysis]. Rev Epidemiol Sante Publique. 2007, 55: 347-356. 10.1016/j.respe.2007.06.003.CrossRefPubMed
42.
Müller G, Kluttig A, Greiser KH, Moebus S, Slomiany U, Schipf S, Völzke H, Maier W, Meisinger C, Tamayo T, Rathmann W, Berger K: Regional and neighborhood disparities in the odds of type 2 diabetes: results from 5 population-based studies in Germany (DIAB-CORE consortium). Am J Epidemiol. 2013, 178: 221-230. 10.1093/aje/kws466.CrossRefPubMed
43.
Auchincloss AH, Diez Roux AV, Mujahid MS, Shen M, Bertoni AG, Carnethon MR: Neighborhood resources for physical activity and healthy foods and incidence of type 2 diabetes mellitus: the Multi-Ethnic study of Atherosclerosis. Arch Intern Med. 2009, 169: 1698-1704. 10.1001/archinternmed.2009.302.CrossRefPubMedPubMedCentral
44.
van Jaarsveld CH, Miles A, Wardle J: Pathways from deprivation to health differed between individual and neighborhood-based indices. J Clin Epidemiol. 2007, 60: 712-719. 10.1016/j.jclinepi.2006.10.005.CrossRefPubMed
45.
Braubach M, Fairburn J: Social inequities in environmental risks associated with housing and residential location – a review of evidence. Eur J Public Health. 2010, 20: 36-42. 10.1093/eurpub/ckp221.CrossRefPubMed
46.
Boullu-Ciocca S, Verger P, Bocquier A, Oliver C: [Corticotropic axis and chronic stress in abdominal obesity and metabolic syndrome]. Presse Med. 2005, 34: 1646-1653. 10.1016/S0755-4982(05)84242-3.CrossRefPubMed
Metadata
Title
Area deprivation and the prevalence of type 2 diabetes and obesity: analysis at the municipality level in Germany
Authors
Nina Grundmann
Andreas Mielck
Martin Siegel
Werner Maier
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2014
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-14-1264

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