title: Association of neighbourhood unemployment rate with incident Type 2 diabetes mellitus in five German regions.
abstract: OBJECTIVE
  To analyse the association of neighbourhood unemployment with incident self-reported physician-diagnosed Type 2 diabetes in a population aged 45-74 years from five German regions.
  
  
  METHODS
  Study participants were linked via their addresses at baseline to particular neighbourhoods. Individual-level data from five population-based studies were pooled and combined with contextual data on neighbourhood unemployment. Type 2 diabetes was assessed according to a self-reported physician diagnosis of diabetes. We estimated proportional hazard models (Weibull distribution) in order to obtain hazard ratios and 95% CIs of Type 2 diabetes mellitus, taking into account interval-censoring and clustering.
  
  
  RESULTS
  We included 7250 participants residing in 228 inner city neighbourhoods in five German regions in our analysis. The incidence rate was 12.6 per 1000 person-years (95% CI 11.4-13.8). The risk of Type 2 diabetes mellitus was higher in men [hazard ratio 1.79 (95% CI 1.47-2.18)] than in women and higher in people with a low education level [hazard ratio 1.55 (95% CI 1.18-2.02)] than in those with a high education level. Independently of individual-level characteristics, we found a higher risk of Type 2 diabetes mellitus in neighbourhoods with high levels of unemployment [quintile 5; hazard ratio 1.72 (95% CI 1.23-2.42)] than in neighbourhoods with low unemployment (quintile 1).
  
  
  CONCLUSIONS
  Low education level and high neighbourhood unemployment were independently associated with an elevated risk of Type 2 diabetes mellitus. Studies examining the impact of the residential environment on Type 2 diabetes mellitus will provide knowledge that is essential for the identification of high-risk populations.
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Müller
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Wellmann
authors.affiliation: Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
authors.forename: S
authors.initials: S
authors.lastname: Hartwig
authors.affiliation: Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.|Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany.
authors.forename: K H
authors.initials: KH
authors.lastname: Greiser
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Moebus
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: K-H
authors.initials: KH
authors.lastname: Jöckel
authors.affiliation: Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schipf
authors.affiliation: Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.|German Centre of Cardiovascular Research, Site Greifswald, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Völzke
authors.affiliation: Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Maier
authors.affiliation: Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Epidemiology II, Neuherberg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Meisinger
authors.affiliation: Institute of Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Tamayo
authors.affiliation: Institute of Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Rathmann
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Berger
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D014478:Unemployment / Q000706:statistics & numerical data*