Social inequalities in health. The case of Diabetes Mellitus: cross sectional study among the Galician population
Main Article Content
Abstract
The relationship between social circumstances and health is widely assumed by the scientific community. It can be said that inequality is cause and effect of the disease. This work adds to the epidemiological work on Diabetes Mellitus (DM), but in this case, it emphasizes the influence of social factors. The objective is to illustrate how diabetes mellitus impacts on the population, according to their socioeconomic conditions. First, this paper reviews most recent theories supporting the association between social factors and disease. Also, to achieve the purposed goals, an exhaustive exploitation of secondary data has been carried out. Data were mainly gathered from the National Health Survey, carried out by the Statistics National Institute on a sample of 37.500 individuals, in Spain, in year 2017. Besides, an ad hoc survey among the diabetic population was carried out in the Galician region, at the northwestern Spain, Sample size was fixed, in this case, on 512 diabetics. From these collected data, statistical tests were performed, such as contingency tables and other association tests, to check the relationship between the dependent variable prevalence of diabetes and explicatory variables social class, family income and educational level. Among the results, we can indicate an inverse relationship between social class and the prevalence of diabetes, which is higher among people with fewer resources and, especially, with a lower educational level.
Keywords:
Diabetes, prevalence, inequalities, health, social class
Article Details
How to Cite
REY, Maria José López; DOCAMPO, Manuel García.
Social inequalities in health. The case of Diabetes Mellitus: cross sectional study among the Galician population.
Medical Research Archives, [S.l.], v. 11, n. 4, apr. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3735>. Date accessed: 27 apr. 2024.
doi: https://doi.org/10.18103/mra.v11i4.3735.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. WHO, 2019. https://www.who.int/es/news-room/fact-sheets/detail/the-top-10-causes-of-death
2. WHO, 2022. https://www.who.int/es/news-room/fact-sheets/detail/diabetes
3. Arnaud, A., Fagot-Campagna, A., Reach, G., Basin, C. & Laporte, A. (2010). Prevalence and characteristics of diabetes among homeless people attending shelters in Paris, France, 2006.
4. Jaffiol, C., Thomas, F., Bean, K., Jégo, B. Y Danchin, N. (2013). Impact of socioeconomic status on diabetes and cardiovascular risk factors: results of a large French survey. Diabetes & Metabolism 39(1), 56-62
5. Denis, B., Bellefontaine, V., Marganne, M., Somassè, E. & Drielsma, P. (2011). Type 2 Diabetes Mellitus prevalence and social inequalities for health. Revue Médicale de Bruxelles 32(1), 10-13
6. Nicklett, E.J. (2011). Socioeconomic status and race/ethnicity independently predict health decline (version electronica). BMC Public Health 2(11), 684
7. Zhang, H., Xu, W., Dahl, A. K., Xu, Z., Wang, H. X. & Qi, X. (2013). Relation of socio-economic status to impaired fasting glucose and Type 2 diabetes: findings based on a large population-based cross-sectional study in Tianjin, China. Diabetic Medicine 30(5), e157-162
8. Tanaka, T., Gjonça, E. & Gulliford, M. C. (2012). Income, wealth and risk of diabetes among older adults: cohort study using the English longitudinal study of ageing. European Journal of Public Health 22(3), 310-317
9. Grigsby-Toussaint, D. S., Lipton, R., Chavez, N., Handler, A., Johnson, T. P. & Kubo J. (2010). Neighborhood socioeconomic change and diabetes risk: findings from the Chicago childhood
10. Gary-Webb, T. L, Baptiste-Roberts, K., Pham, L., Wesche-Thobaben, J., Patricio, J., Pi-Sunyer, F. X., Brown, A. F, Jones-Corneille, L., Brancati, F. L. & Look Ahead Research Group. (2011). Neighborhood socioeconomic status, depression, and health status in the Look (versión electrónica). BMC Public Health 11,349
11. Williams, E. D., Magliano, D. J., Zimmet, P. Z., Kavanagh, A. M., StevNHSon, C. E. & Oldenburg, B. F. (2012). Area-level socioeconomic status and incidence of abnormal glucose metabolism: the Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Diabetes Care 35(7), 1455-1461
12, Müller, G., Kluttig. A., Greiser, K. H., Moebus, S., Slomiany, U., Schipf, S., Völzke, H,, Maier, W., Meisinger, C., Tamayo, T., Rathmann, W, & Berger, K. (2013). Regional and neighborhood disparities in the odds of type 2 diabetes: results from 5 population-based studies in Germany (DIAB-CORE consortium). American Journal of Epidemiology 178(2), 221-230
13. Elgart, J. F., Caporale, J. E., Asteazarán, S., De La Fuente, J. L., Camilluci, C., Brown, J. B., González, C. D. & Gagliardino, J. J. (2014). Association between socioeconomic status, type 2 diabetes and its chronic complications in Argentina. Diabetes Research and Clinical Practice 104(2), 241-7
14. Dijkstra, A., Janssen, F., De Bakker, M., Bos, J., Lub, R., Van Wissen, L. J. & Hak, E. (2013). Using spatial analysis to predict health care use at the local level: a case study of type 2 diabetes medication use and its association with demographic change and socioeconomic status (versión electrónica). PLoS One 8(8), e72730
15. Piper, C. N., Polite-Middleton, T., Warren-Findlow, J., Thompson, M. E., Sebastian, N. & Akindahunsi, Y. (2013). Racial influences on diabetes management among adults in North Carolina. Ethnicity & Disease 23(3), 316-321
16. Connolly, V. M., Unwin, N., Sherriff, P., Bilous, R. & Kelly W. (2000). Diabetes prevalence and socioeconomic status: a population-based study showing increased prevalence of type 2 Diabetes Mellitus in deprived areas. Journal of Epidemiology and Community Health 54, 173-177
17. Jarosz-Chobot, P. & Polanska, J. (2004). Does social-economic transformation influence of incidence of Type 1 Diabetes Mellitus? (versión electrónica). Annual Meeting Munich 289
18. Campbell, D. D., Parra, M. V., Duque, C., Gallego, N., Franco, L., Tandon, A. & Hünemeier, T. (2012). Amerind ancestry, socioeconomic status and the genetics of type 2 diabetes in a Colombian population. (vesión electronica). PLoS One 7(4), e33570European Journal of Public Health 20(5), 601-603
19. Mckinlay, J. B., Marceau, L. D. & Piccolo, R. J. (2013). Do doctors contribute to the social patterning of disease? The case of race/ethnic disparities in Diabetes Mellitus. Medical Care Research and Review 69(2), 176-193
20. Staines, A., Hanif, S., Ahmed, S., Mckinney, P. A., Shera, S. & Bodansky, H. J. (1997). Incidence of insulin dependent Diabetes Mellitus in Karachi, Pakistan. Archives of Diseases of Children 76(2), 121-123diabetes. Diabetes Care 36(1), 49-55
21. Abouzeid, M., Philpot, B., Janus, E. D., Coates, M. J. & Dunbar, J. A. (2013). Type 2 diabetes prevalence varies by socio-economic status within and between migrant groups: analysis and implications for Australia (versión electrónica). BMC Public Health 13, 252
22. Afable-Munsuz, A., Mayeda, E. R., Pérez-Stable, E. J. & Haan, M. N. (2013). Immigrant generation and diabetes risk among Mexican Americans: the Sacramento. American Journal of Public Health 103(5), 45-52
23. Pubudu De Silva, A., Padmal De Silva, S. H., Liyanage, I. K., Rajapakse, L. C., Jayasinghe, K. S., Katulanda, P., Wijeratne, C. N. & Wijeratne S. (2012). Social, cultural, and economical determinants of Diabetes Mellitus in Kalutara district, Sri Lanka: a cross sectional descriptive study (versión electrónica). International Journal for Equity in Health 11(76)
24. Ploubidis, G. B., Mathenge, W., De Stavola, B., Grundy, E., Foster, A. & Kuper, H. (2013). Socioeconomic position and later life prevalence of hypertNHSion, diabetes and visual impairment in Nakuru, Kenya. International Journal of Public Health 58(1), 133-141
25. Deepa, M., Anjana, R. M., Manjula, D., Narayan, K. M. & Mohan, V. (2011). Convergence of prevalence rates of diabetes and cardiometabolic risk factors in middle- and low-income groups in urban India: 10-year follow-up of the Chennai Urban Population Study. Journal of Diabetes Science and Technology 5(4), 18-27
26. Espelt, A., Arriola, L., Borrel, L. C., Larrañaga, I., Sandín, M. & Escolar-Pujolar, A. (2011). Socioeconomic position and type 2 Diabetes Mellitus in Europe 1999-2009: a panorama of inequalities. Current Diabetes Reviews 7(3), 148-58
27. Costa-Font, J. & Gil, J. (2008). Una Primera Exploración de las desigualdades Socioeconómicas en Morbilidad en España. Cuadernos económicos de ICE 75, 44-62
28. Saumya Pal, S., Raman, R., Ganesan, S., Sahu, C. & Sharma, T. (2011). Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN--DREAMS III): study design and research methodology (version electronica). BMC Ophthalmology 11(7)
29. Wolf, G., Busch, M., Müller, N. & Müller, U. A. (2011). Association between socioeconomic status and renal function in a population of German patients with diabetic nephropathy treated at a tertiary centre. Nephrology, Dialysis and Transplantation 26(12), 4017-4023
30. Ricci-Cabello, I., Ruiz-Pérez, I., De Labry-Lima, A. O. & Márquez-Calderón, S. (2010). Do social inequalities exist in terms of the prevention, diagnosis, treatment, control, and monitoring of diabetes? A systematic review. Health and Social Care in the Community 18(6), 572-587
31. Karter, A. J., Ferrara, A., Darbinian, J. A., Ackerson, L. M. Y Selby, J. V. (2000). Self-monitoring of blood glucose: language and financial barriers in a managed care population with diabetes. Diabetes Care 23(4), 477-483
32. Hauser, I., Overmann, H., Bender, R., et al. (1998). Estatus social y la calidad de la atención para persona adultas con diabetes tipo 1 (un estudio poblacional). Diabetología 41, 1139-1150diabetes registry. Diabetes Care 33(5), 1065-1068
33. Abby, G. & Ershow, S.C D. (2009). Environmental Influences on Development of Type 2 Diabetes and Obesity: Challenges in Personalizing Prevention and Management. Journal of Diabetes Science and Technology 3(4), 727–734
34. Tabaei, B. P., Chamany, S., Driver, C. R., Kerker, B. & Silver, L. (2012). Incidence of self-reported diabetes in New York City, 2002, 2004, and 2008 (versión electrónica). Preventing Chronic Disease 9, 110320
35. Lee, T. C., Glynn, R. J., Peña, J. M., Paynter, N. P., Conen, D., Ridker, P. M., Pradhan, A. D., Buring, J. E. & Albert, M. A. (2011). Socioeconomic status and incident type 2 Diabetes Mellitus: data from the Women's Health Study (versión electrónica). PLoS One 6(12), e27670
36. Espelt, A. (2008). Socioeconomic inequalities in Diabetes Mellitus across Europe at the beginning of the 21st century. Diabetologia 51(11), 1971-1979
37, Kellar, I. Y Mason, D. (2014). Social patterning in knowledge following an informed choice invitation for type 2 diabetes screening. Diabetic Medicine 31(4), 504-508
38. 31. Karter, A. J., Ferrara, A., Darbinian, J. A., Ackerson, L. M. & Selby, J. V. (2000). Self-monitoring of blood glucose: language and financial barriers in a managed care population with diabetes. Diabetes Care 23(4), 477-483
39. Zheng, Y., Lamoureux, E. L., Chiang, P.C., Anuar, A.R., Ding, J., Wang, J. J., Mitchell, P. & Tai, E.S. (2012). Language barrier and its relationship to diabetes and diabetic retinopathy (versión electrónica). BMC Public Health 12, 781
40. Saydah, S. H., Imperatore, G. & Beckles G. L. (2013). Socioeconomic status and mortality: contribution of health care access and psychological distress among U.S. adults with diagnosed
41. Instituto Nacional De Estadística. (2014). Encuesta europea de Salud en España
42. Goldthorpe, J. H., Llewellyn, C., & Payne, C. (1980). Social mobility and class structure in modern Britain. Oxford: Clarendon Press
43. López Rey, MJ and Docampo García. M. (2018). Change over time in prevalence of diabetes mellitus (DM) in Spain (1999–2014). Endocrinología, Diabetes y Nutrición (English ed.) 65 (9), 515-523
2. WHO, 2022. https://www.who.int/es/news-room/fact-sheets/detail/diabetes
3. Arnaud, A., Fagot-Campagna, A., Reach, G., Basin, C. & Laporte, A. (2010). Prevalence and characteristics of diabetes among homeless people attending shelters in Paris, France, 2006.
4. Jaffiol, C., Thomas, F., Bean, K., Jégo, B. Y Danchin, N. (2013). Impact of socioeconomic status on diabetes and cardiovascular risk factors: results of a large French survey. Diabetes & Metabolism 39(1), 56-62
5. Denis, B., Bellefontaine, V., Marganne, M., Somassè, E. & Drielsma, P. (2011). Type 2 Diabetes Mellitus prevalence and social inequalities for health. Revue Médicale de Bruxelles 32(1), 10-13
6. Nicklett, E.J. (2011). Socioeconomic status and race/ethnicity independently predict health decline (version electronica). BMC Public Health 2(11), 684
7. Zhang, H., Xu, W., Dahl, A. K., Xu, Z., Wang, H. X. & Qi, X. (2013). Relation of socio-economic status to impaired fasting glucose and Type 2 diabetes: findings based on a large population-based cross-sectional study in Tianjin, China. Diabetic Medicine 30(5), e157-162
8. Tanaka, T., Gjonça, E. & Gulliford, M. C. (2012). Income, wealth and risk of diabetes among older adults: cohort study using the English longitudinal study of ageing. European Journal of Public Health 22(3), 310-317
9. Grigsby-Toussaint, D. S., Lipton, R., Chavez, N., Handler, A., Johnson, T. P. & Kubo J. (2010). Neighborhood socioeconomic change and diabetes risk: findings from the Chicago childhood
10. Gary-Webb, T. L, Baptiste-Roberts, K., Pham, L., Wesche-Thobaben, J., Patricio, J., Pi-Sunyer, F. X., Brown, A. F, Jones-Corneille, L., Brancati, F. L. & Look Ahead Research Group. (2011). Neighborhood socioeconomic status, depression, and health status in the Look (versión electrónica). BMC Public Health 11,349
11. Williams, E. D., Magliano, D. J., Zimmet, P. Z., Kavanagh, A. M., StevNHSon, C. E. & Oldenburg, B. F. (2012). Area-level socioeconomic status and incidence of abnormal glucose metabolism: the Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Diabetes Care 35(7), 1455-1461
12, Müller, G., Kluttig. A., Greiser, K. H., Moebus, S., Slomiany, U., Schipf, S., Völzke, H,, Maier, W., Meisinger, C., Tamayo, T., Rathmann, W, & Berger, K. (2013). Regional and neighborhood disparities in the odds of type 2 diabetes: results from 5 population-based studies in Germany (DIAB-CORE consortium). American Journal of Epidemiology 178(2), 221-230
13. Elgart, J. F., Caporale, J. E., Asteazarán, S., De La Fuente, J. L., Camilluci, C., Brown, J. B., González, C. D. & Gagliardino, J. J. (2014). Association between socioeconomic status, type 2 diabetes and its chronic complications in Argentina. Diabetes Research and Clinical Practice 104(2), 241-7
14. Dijkstra, A., Janssen, F., De Bakker, M., Bos, J., Lub, R., Van Wissen, L. J. & Hak, E. (2013). Using spatial analysis to predict health care use at the local level: a case study of type 2 diabetes medication use and its association with demographic change and socioeconomic status (versión electrónica). PLoS One 8(8), e72730
15. Piper, C. N., Polite-Middleton, T., Warren-Findlow, J., Thompson, M. E., Sebastian, N. & Akindahunsi, Y. (2013). Racial influences on diabetes management among adults in North Carolina. Ethnicity & Disease 23(3), 316-321
16. Connolly, V. M., Unwin, N., Sherriff, P., Bilous, R. & Kelly W. (2000). Diabetes prevalence and socioeconomic status: a population-based study showing increased prevalence of type 2 Diabetes Mellitus in deprived areas. Journal of Epidemiology and Community Health 54, 173-177
17. Jarosz-Chobot, P. & Polanska, J. (2004). Does social-economic transformation influence of incidence of Type 1 Diabetes Mellitus? (versión electrónica). Annual Meeting Munich 289
18. Campbell, D. D., Parra, M. V., Duque, C., Gallego, N., Franco, L., Tandon, A. & Hünemeier, T. (2012). Amerind ancestry, socioeconomic status and the genetics of type 2 diabetes in a Colombian population. (vesión electronica). PLoS One 7(4), e33570European Journal of Public Health 20(5), 601-603
19. Mckinlay, J. B., Marceau, L. D. & Piccolo, R. J. (2013). Do doctors contribute to the social patterning of disease? The case of race/ethnic disparities in Diabetes Mellitus. Medical Care Research and Review 69(2), 176-193
20. Staines, A., Hanif, S., Ahmed, S., Mckinney, P. A., Shera, S. & Bodansky, H. J. (1997). Incidence of insulin dependent Diabetes Mellitus in Karachi, Pakistan. Archives of Diseases of Children 76(2), 121-123diabetes. Diabetes Care 36(1), 49-55
21. Abouzeid, M., Philpot, B., Janus, E. D., Coates, M. J. & Dunbar, J. A. (2013). Type 2 diabetes prevalence varies by socio-economic status within and between migrant groups: analysis and implications for Australia (versión electrónica). BMC Public Health 13, 252
22. Afable-Munsuz, A., Mayeda, E. R., Pérez-Stable, E. J. & Haan, M. N. (2013). Immigrant generation and diabetes risk among Mexican Americans: the Sacramento. American Journal of Public Health 103(5), 45-52
23. Pubudu De Silva, A., Padmal De Silva, S. H., Liyanage, I. K., Rajapakse, L. C., Jayasinghe, K. S., Katulanda, P., Wijeratne, C. N. & Wijeratne S. (2012). Social, cultural, and economical determinants of Diabetes Mellitus in Kalutara district, Sri Lanka: a cross sectional descriptive study (versión electrónica). International Journal for Equity in Health 11(76)
24. Ploubidis, G. B., Mathenge, W., De Stavola, B., Grundy, E., Foster, A. & Kuper, H. (2013). Socioeconomic position and later life prevalence of hypertNHSion, diabetes and visual impairment in Nakuru, Kenya. International Journal of Public Health 58(1), 133-141
25. Deepa, M., Anjana, R. M., Manjula, D., Narayan, K. M. & Mohan, V. (2011). Convergence of prevalence rates of diabetes and cardiometabolic risk factors in middle- and low-income groups in urban India: 10-year follow-up of the Chennai Urban Population Study. Journal of Diabetes Science and Technology 5(4), 18-27
26. Espelt, A., Arriola, L., Borrel, L. C., Larrañaga, I., Sandín, M. & Escolar-Pujolar, A. (2011). Socioeconomic position and type 2 Diabetes Mellitus in Europe 1999-2009: a panorama of inequalities. Current Diabetes Reviews 7(3), 148-58
27. Costa-Font, J. & Gil, J. (2008). Una Primera Exploración de las desigualdades Socioeconómicas en Morbilidad en España. Cuadernos económicos de ICE 75, 44-62
28. Saumya Pal, S., Raman, R., Ganesan, S., Sahu, C. & Sharma, T. (2011). Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN--DREAMS III): study design and research methodology (version electronica). BMC Ophthalmology 11(7)
29. Wolf, G., Busch, M., Müller, N. & Müller, U. A. (2011). Association between socioeconomic status and renal function in a population of German patients with diabetic nephropathy treated at a tertiary centre. Nephrology, Dialysis and Transplantation 26(12), 4017-4023
30. Ricci-Cabello, I., Ruiz-Pérez, I., De Labry-Lima, A. O. & Márquez-Calderón, S. (2010). Do social inequalities exist in terms of the prevention, diagnosis, treatment, control, and monitoring of diabetes? A systematic review. Health and Social Care in the Community 18(6), 572-587
31. Karter, A. J., Ferrara, A., Darbinian, J. A., Ackerson, L. M. Y Selby, J. V. (2000). Self-monitoring of blood glucose: language and financial barriers in a managed care population with diabetes. Diabetes Care 23(4), 477-483
32. Hauser, I., Overmann, H., Bender, R., et al. (1998). Estatus social y la calidad de la atención para persona adultas con diabetes tipo 1 (un estudio poblacional). Diabetología 41, 1139-1150diabetes registry. Diabetes Care 33(5), 1065-1068
33. Abby, G. & Ershow, S.C D. (2009). Environmental Influences on Development of Type 2 Diabetes and Obesity: Challenges in Personalizing Prevention and Management. Journal of Diabetes Science and Technology 3(4), 727–734
34. Tabaei, B. P., Chamany, S., Driver, C. R., Kerker, B. & Silver, L. (2012). Incidence of self-reported diabetes in New York City, 2002, 2004, and 2008 (versión electrónica). Preventing Chronic Disease 9, 110320
35. Lee, T. C., Glynn, R. J., Peña, J. M., Paynter, N. P., Conen, D., Ridker, P. M., Pradhan, A. D., Buring, J. E. & Albert, M. A. (2011). Socioeconomic status and incident type 2 Diabetes Mellitus: data from the Women's Health Study (versión electrónica). PLoS One 6(12), e27670
36. Espelt, A. (2008). Socioeconomic inequalities in Diabetes Mellitus across Europe at the beginning of the 21st century. Diabetologia 51(11), 1971-1979
37, Kellar, I. Y Mason, D. (2014). Social patterning in knowledge following an informed choice invitation for type 2 diabetes screening. Diabetic Medicine 31(4), 504-508
38. 31. Karter, A. J., Ferrara, A., Darbinian, J. A., Ackerson, L. M. & Selby, J. V. (2000). Self-monitoring of blood glucose: language and financial barriers in a managed care population with diabetes. Diabetes Care 23(4), 477-483
39. Zheng, Y., Lamoureux, E. L., Chiang, P.C., Anuar, A.R., Ding, J., Wang, J. J., Mitchell, P. & Tai, E.S. (2012). Language barrier and its relationship to diabetes and diabetic retinopathy (versión electrónica). BMC Public Health 12, 781
40. Saydah, S. H., Imperatore, G. & Beckles G. L. (2013). Socioeconomic status and mortality: contribution of health care access and psychological distress among U.S. adults with diagnosed
41. Instituto Nacional De Estadística. (2014). Encuesta europea de Salud en España
42. Goldthorpe, J. H., Llewellyn, C., & Payne, C. (1980). Social mobility and class structure in modern Britain. Oxford: Clarendon Press
43. López Rey, MJ and Docampo García. M. (2018). Change over time in prevalence of diabetes mellitus (DM) in Spain (1999–2014). Endocrinología, Diabetes y Nutrición (English ed.) 65 (9), 515-523