title: 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.
abstract: OBJECTIVE
  There is increasing evidence that prevention programmes for type 2 diabetes mellitus (T2DM) and obesity need to consider individual and regional risk factors. Our objective is to assess the independent association of area level deprivation with T2DM and obesity controlling for individual risk factors in a large study covering the whole of Germany.
  
  
  METHODS
  We combined data from two consecutive waves of the national health interview survey 'GEDA' conducted by the Robert Koch Institute in 2009 and 2010. Data collection was based on computer-assisted telephone interviews. After exclusion of participants <30 years of age and those with missing responses, we included n=33,690 participants in our analyses. The outcome variables were the 12-month prevalence of known T2DM and the prevalence of obesity (BMI ≥ 30 kg/m(2)). We also controlled for age, sex, BMI, smoking, sport, living with a partner and education. Area level deprivation of the districts was defined by the German Index of Multiple Deprivation. Logistic multilevel regression models were performed using the software SAS 9.2.
  
  
  RESULTS
  Of all men and women living in the most deprived areas, 8.6% had T2DM and 16.9% were obese (least deprived areas: 5.8% for T2DM and 13.7% for obesity). For women, higher area level deprivation and lower educational level were both independently associated with higher T2DM and obesity prevalence [highest area level deprivation: OR 1.28 (95% CI: 1.05-1.55) for T2DM and OR 1.28 (95% CI: 1.10-1.49) for obesity]. For men, a similar association was only found for obesity [OR 1.20 (95% CI: 1.02-1.41)], but not for T2DM.
  
  
  CONCLUSIONS
  Area level deprivation is an independent, important determinant of T2DM and obesity prevalence in Germany. Identifying and targeting specific area-based risk factors should be considered an essential public health issue relevant to increasing the effectiveness of diabetes and obesity prevention.
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Maier
authors.affiliation: Robert Koch Institute, Berlin, Germany.
authors.forename: Christa
authors.initials: C
authors.lastname: Scheidt-Nave
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Holle
authors.affiliation: Robert Koch Institute, Berlin, Germany.
authors.forename: Lars E
authors.initials: LE
authors.lastname: Kroll
authors.affiliation: Robert Koch Institute, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lampert
authors.affiliation: Robert Koch Institute, Berlin, Germany.
authors.forename: Yong
authors.initials: Y
authors.lastname: Du
authors.affiliation: Robert Koch Institute, Berlin, Germany.
authors.forename: Christin
authors.initials: C
authors.lastname: Heidemann
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Mielck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D016017:Odds Ratio; D015995:Prevalence; D062486:Public Health Surveillance; D012307:Risk Factors