title: 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.
abstract: OBJECTIVE
  Our objective was to test the hypothesis that the prevalence of Type 2 diabetes increases with increasing regional deprivation even after controlling for individual socio-economic status.
  
  
  METHODS
  We pooled cross-sectional data from five German population-based studies. The data set contained information on n = 11,688 study participants (men 50.1%) aged 45-74 years, of whom 1008 people had prevalent Type 2 diabetes (men 56.2%). Logistic multilevel regression was performed to estimate odds ratios (OR) and 95% confidence intervals (CI) for diabetes prevalence. We controlled for sex, age and lifestyle risk factors, individual socio-economic status and regional deprivation, based on a new small-area deprivation measure, the German Index of Multiple Deprivation.
  
  
  RESULTS
  Adjusted for sex, age, body mass index (BMI), physical activity, smoking status and alcohol consumption, the prevalence of Type 2 diabetes showed a stepwise increase in risk with increasing area deprivation [OR 1.88 (95% CI 1.16-3.04) in quintile 4 and OR 2.14 (95% CI 1.29-3.55) in quintile 5 compared with the least deprived quintile 1], even after controlling for individual socio-economic status. Focusing on individual socio-economic status alone, the risk of having diabetes was significantly higher for low compared with medium or high educational level [OR 1.46 (95% CI 1.24-1.71)] and for the lowest compared with the highest income group [OR 1.53 (95% CI 1.18-1.99)].
  
  
  CONCLUSIONS
  Regional deprivation plays a significant part in the explanation of diabetes prevalence in Germany independently of individual socio-economic status. The results of the present study could help to target public health measures in deprived regions.
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany. werner.maier@helmholtz-muenchen.de
authors.forename: W
authors.initials: W
authors.lastname: Maier
authors.forename: R
authors.initials: R
authors.lastname: Holle
authors.forename: M
authors.initials: M
authors.lastname: Hunger
authors.forename: A
authors.initials: A
authors.lastname: Peters
authors.forename: C
authors.initials: C
authors.lastname: Meisinger
authors.forename: K H
authors.initials: KH
authors.lastname: Greiser
authors.forename: A
authors.initials: A
authors.lastname: Kluttig
authors.forename: H
authors.initials: H
authors.lastname: Völzke
authors.forename: S
authors.initials: S
authors.lastname: Schipf
authors.forename: S
authors.initials: S
authors.lastname: Moebus
authors.forename: B
authors.initials: B
authors.lastname: Bokhof
authors.forename: K
authors.initials: K
authors.lastname: Berger
authors.forename: G
authors.initials: G
authors.lastname: Mueller
authors.forename: W
authors.initials: W
authors.lastname: Rathmann
authors.forename: T
authors.initials: T
authors.lastname: Tamayo
authors.forename: A
authors.initials: A
authors.lastname: Mielck
mesh_terms: D017677:Age Distribution; D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D005858:Germany / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D007182:Income; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D017678:Sex Distribution; D012959:Socioeconomic Factors