title: Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century.
abstract: OBJECTIVE
  The aim of this study was to determine and quantify socioeconomic position (SEP) inequalities in diabetes mellitus in different areas of Europe, at the turn of the century, for men and women.
  
  
  METHODS
  We analysed data from ten representative national health surveys and 13 mortality registers. For national health surveys the dependent variable was the presence of diabetes by self-report and for mortality registers it was death from diabetes. Educational level (SEP), age and sex were independent variables, and age-adjusted prevalence ratios (PRs) and risk ratios (RRs) were calculated.
  
  
  RESULTS
  In the overall study population, low SEP was related to a higher prevalence of diabetes, for example men who attained a level of education equivalent to lower secondary school or less had a PR of 1.6 (95% CI 1.4-1.9) compared with those who attained tertiary level education, whereas the corresponding value in women was 2.2 (95% CI 1.9-2.7). Moreover, in all countries, having a disadvantaged SEP is related to a higher rate of mortality from diabetes and a linear relationship is observed. Eastern European countries have higher relative inequalities in mortality by SEP. According to our data, the RR of dying from diabetes for women with low a SEP is 3.4 (95% CI 2.6-4.6), while in men it is 2.0 (95% CI 1.7-2.4).
  
  
  CONCLUSIONS
  In Europe, educational attainment and diabetes are inversely related, in terms of both morbidity and mortality rates. This underlines the importance of targeting interventions towards low SEP groups. Access and use of healthcare services by people with diabetes also need to be improved.
authors.affiliation: Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Spain. aespelt@aspb.cat
authors.forename: A
authors.initials: A
authors.lastname: Espelt
authors.forename: C
authors.initials: C
authors.lastname: Borrell
authors.forename: A J
authors.initials: AJ
authors.lastname: Roskam
authors.forename: M
authors.initials: M
authors.lastname: Rodríguez-Sanz
authors.forename: I
authors.initials: I
authors.lastname: Stirbu
authors.forename: A
authors.initials: A
authors.lastname: Dalmau-Bueno
authors.forename: E
authors.initials: E
authors.lastname: Regidor
authors.forename: M
authors.initials: M
authors.lastname: Bopp
authors.forename: P
authors.initials: P
authors.lastname: Martikainen
authors.forename: M
authors.initials: M
authors.lastname: Leinsalu
authors.forename: B
authors.initials: B
authors.lastname: Artnik
authors.forename: J
authors.initials: J
authors.lastname: Rychtarikova
authors.forename: R
authors.initials: R
authors.lastname: Kalediene
authors.forename: D
authors.initials: D
authors.lastname: Dzurova
authors.forename: J
authors.initials: J
authors.lastname: Mackenbach
authors.forename: A E
authors.initials: AE
authors.lastname: Kunst
mesh_terms: D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000401:mortality; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011203:Poverty; D015995:Prevalence; D012959:Socioeconomic Factors
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