Text

Background/Aim: Diabetes mellitus is one of Germany’s major health policy challenges, with a prevalence in 2024 of 10.3% in the adult population (men 11.6%, women 9.0%) [1]. Type 2 diabetes (T2D) accounts for 90-95% of all diabetes cases. Prior evidence suggests that the risk of developing T2D is associated with low socioeconomic status [2]. The aim of this study is to comprehensively characterize socioeconomic factors (income, occupational status and education) of T2D in the German National Cohort (NAKO).

Methods: Descriptive statistics and binary logistic regression were used to identify potential influencing factors among individuals with and without T2D in a cross-sectional analysis. From the NAKO baseline cohort (n = 204,605) [3], participants with missing data on age or sex, missing or inconsistent drug utilization data, and those with type 1, gestational or unclear diabetes status were excluded. The final study cohort consisted of 10,096 individuals with T2D and 187,795 without diabetes. We analyzed socioeconomic exposure including monthly net equivalent income, occupational status (ISEI), and educational achievement (ISCED-11) and adjusted for smoking, alcohol consumption, and physical activity.

Results: The prevalence of T2D in our study cohort was 5.05%. Among persons with T2D the majority was male (61.22%) while sex was almost equally distributed among persons without diabetes (49.21% male). Individuals with T2D tended to be older on average (60.54 ± 7.70 years) than those without diabetes (49.29 ± 12.73 years). About one third of the Individuals with T2D were in the lowest income deciles D1 and D2, whereas participants without diabetes tended to belong to higher income deciles (one fifth in D9 and D10). Similar patterns were also evident in occupational status and education. Binary logistic regression showed a socioeconomic gradient in all three factors with low odds for higher socioeconomic levels and high odds in lower socioeconomic levels.

Discussion/Conclusion: T2D was consistently associated with higher odds in lower socioeconomic levels across all three factors examined (income, occupation and education), mostly pronounced for education. These associations persisted after adjustment for smoking, alcohol consumption, and physical activity, suggesting that factors beyond individual health behaviour contribute to the socioeconomic gradient. Our findings support the relevance of socioeconomic factors for comprehensive diabetes care and guideline development. Analyses of potential associations of psychosocial factors as well as patient- and medication-related factors with diabetes status are planned for the next future.

Literatur

[1] Robert-Koch-Institut. Gesundheitsberichtserstattung - Diabetes mellitus: Prävalenz (ab 18 Jahre). 2025. Available from: https://www.gbe.rki.de/DE/Themen/Gesundheitszustand/KoerperlicheErkrankungen/DiabetesMellitus/DiabetesPraevalenz18Plus/diabetesPraevalenz_node.html?darstellung=0&kennzahl=1&zeit=2024&geschlecht=0&standardisierung=0#_7pjzgaq5x
[2] Agardh E, Allebeck P, Hallqvist J, Moradi T, Sidorchuk A. Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. Int J Epidemiol. 2011 Jun;40(3):804-18. DOI: 10.1093/ije/dyr029
[3] Peters A, Greiser KH, Göttlicher S, Ahrens W, Albrecht M, et al. Framework and baseline examination of the German National Cohort (NAKO). Eur J Epidemiol. 2022 Oct;37(10):1107-24. DOI: 10.1007/s10654-022-00890-5