TY - JOUR
T1 - Lower educational level is a predictor of incident type 2 diabetes in European countries
T2 - the EPIC-InterAct study
AU - Sacerdote, Carlotta
AU - Ricceri, Fulvio
AU - Rolandsson, Olov
AU - Baldi, Ileana
AU - Chirlaque, Maria-Dolores
AU - Feskens, Edith
AU - Bendinelli, Benedetta
AU - Ardanaz, Eva
AU - Arriola, Larraitz
AU - Balkau, Beverley
AU - Bergmann, Manuela
AU - Beulens, Joline W J
AU - Boeing, Heiner
AU - Clavel-Chapelon, Françoise
AU - Crowe, Francesca
AU - de Lauzon-Guillain, Blandine
AU - Forouhi, Nita
AU - Franks, Paul W
AU - Gallo, Valentina
AU - Gonzalez, Carlos
AU - Halkjær, Jytte
AU - Illner, Anne-Kathrin
AU - Kaaks, Rudolf
AU - Key, Timothy
AU - Khaw, Kay-Tee
AU - Navarro, Carmen
AU - Nilsson, Peter M
AU - Dal Ton, Susanne Oksbjerg
AU - Overvad, Kim
AU - Pala, Valeria
AU - Palli, Domenico
AU - Panico, Salvatore
AU - Polidoro, Silvia
AU - Quirós, J Ramón
AU - Romieu, Isabelle
AU - Sánchez, María-José
AU - Slimani, Nadia
AU - Sluijs, Ivonne
AU - Spijkerman, Annemieke
AU - Teucher, Birgit
AU - Tjønneland, Anne
AU - Tumino, Rosario
AU - van der A, Daphne
AU - Vergnaud, Anne-Claire
AU - Wennberg, Patrik
AU - Sharp, Stephen
AU - Langenberg, Claudia
AU - Riboli, Elio
AU - Vineis, Paolo
AU - Wareham, Nicholas
PY - 2012/8
Y1 - 2012/8
N2 - 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.
AB - 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.
KW - Age Factors
KW - Case-Control Studies
KW - Demography
KW - Diabetes Mellitus, Type 2/epidemiology
KW - Educational Status
KW - Europe/epidemiology
KW - Female
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Proportional Hazards Models
KW - Risk Factors
KW - Socioeconomic Factors
KW - Surveys and Questionnaires
U2 - 10.1093/ije/dys091
DO - 10.1093/ije/dys091
M3 - Article
C2 - 22736421
SN - 0300-5771
VL - 41
SP - 1162
EP - 1173
JO - International Journal of Epidemiology
JF - International Journal of Epidemiology
IS - 4
ER -