title: Area deprivation and the prevalence of type 2 diabetes and obesity: analysis at the municipality level in Germany.
abstract: BACKGROUND
  The objective of this study was to analyse the association between area deprivation at municipality level and the prevalence of type 2 diabetes (T2D) and obesity across Germany, controlling for individual socioeconomic status (SES).
  
  
  METHODS
  The analyses are based on a large survey conducted in 2006. Information was included from 39,908 adults aged 20 years or above. Area deprivation was assessed using the German Index of Multiple Deprivation (GIMD) at municipality level. About 4,700 municipalities could be included and assigned to a deprivation quintile. Individual SES was assessed by income and educational level. Multilevel logistic models were used to control for individual SES and other potential confounders such as age, sex and physical activity.
  
  
  RESULTS
  We found a positive association of area deprivation with T2D and obesity. Controlling for all individual-level variables, the odds ratios for municipalities in the most deprived quintile were significantly increased for T2D (OR 1.35; 95% CI 1.12-1.64) as well as for obesity (OR 1.14; 95% CI 1.02-1.26). Further analyses showed that these associations were relatively similar for both men and women.
  
  
  CONCLUSIONS
  Based on a nationwide dataset, we were able to show that area deprivation at municipality level is significantly associated with the prevalence of T2D and obesity. It will be important to focus preventive efforts on very deprived municipalities.
authors.forename: Nina
authors.initials: N
authors.lastname: Grundmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Mielck
authors.forename: Martin
authors.initials: M
authors.lastname: Siegel
authors.affiliation: Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany. werner.maier@helmholtz-muenchen.de.
authors.forename: Werner
authors.initials: W
authors.lastname: Maier
mesh_terms: D000328:Adult; D000368:Aged; D002947:Cities; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D011204:Poverty Areas; D015995:Prevalence; D012923:Social Class; D011795:Surveys and Questionnaires; D044465:White People; D055815:Young Adult