The role of socio-economic deprivation in developing of Obesity and Diabetes type 2 among population aged 16 and over in England and Sweden, 2021-2024
Main Article Content
Abstract
Background: Diabetes type 2 is the fastest growing non-communicable endocrine disease affecting over 830 million people globally. Diabetes complications include cardiovascular and renal disorders, loss of vision and foot amputations. Obesity is a complex chronic disease defined by excessive fat deposits which negatively impact health and the main risk factor of diabetes type 2. Similarly to diabetes type 2, prevalence of obesity shows a negative increasing trend. Obesity in adults has doubled since 1990, and fourfold in children and adolescents. According to several research studies, both obesity and diabetes type 2 have the same social determinants as social and socio-economic deprivation, isolation, low level of education and unhealthy eating habits.
Aim: The aim of this research is to examine the role of socio-economic deprivation in an increasing trend and prevalence of obesity and diabetes type 2 among people aged 16+ in England and Sweden, based on the routine epidemiological data for 2021-2024 years.
Methods: A statistical analysis is based on 61 England counties & unitary authorities, of these 16 counties relate to the most and second most deprived areas of England, and 15 to the least and second least ones. By simple random sampling technique 31 counties & unitary authorities were randomly picked for the analysis. Pearson’s product-moment correlation coefficient and multiple regression analyses were used to investigate possible associations, their strength and direction between the prevalence of diabetes, socio-economic deprivation, obesity and daily fruit and vegetables consumption. Data on four health indicators were retrieved from the England’s electronic database – Public Health Profiles. For Sweden, seven health indicators reflecting the prevalence of diabetes, obesity, economic standard and level of daily fruit, berries and vegetables intake, according to socio-economic area type and income quantile were extracted from the Swedish Public Health Database. A comparative analysis and visual presentation of results were implemented for Sweden.
Findings: For both countries, positive associations were revealed between socio-economic deprivation, prevalence of obesity and diabetes type 2. In addition to this, the overall low consumption of fruit and vegetables was detected in low-income areas, with socio-economic challenges. This research showed that the prevalence of obesity and diabetes type 2 is increasing, and conversely, daily fruit and vegetables consumption is decreasing with the increase in deprivation level of area. The results of the statistical analysis for England showed high statistical significance and a strong level of associations revealed.
Conclusion: In conclusion, the analysis of the routine epidemiological data for 2021-2024 years in England and Sweden showed that socio-economic deprivation is associated with higher prevalence of diabetes type 2 and obesity among people aged 16+ in both countries. Increase in a deprivation level has linear relationships with the prevalence of obesity and diabetes type 2. Additionally, areas with higher deprivation status, prevalence of obesity and diabetes type 2 demonstrate lower daily consumption of fruits and vegetables compared to areas with good socio-economic conditions. Overall, socio-economic deprivation plays a significant role in increasing trends for both obesity and diabetes type 2.
Funding: No funding was provided for this article, and the author has nothing to declare.
Article Details
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
2. Office for Health Improvement and Disparities. Official Statistics. Diabetes profile: statistical commentary, March 2025. 2025. https://www.gov.uk/government/statistics/diabetes-profile-update-march-2025/diabetes-profile-statistical-commentary-march-2025 Accessed June 23, 2025
3. Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2021. Results. Institute for Health Metrics and Evaluation. 2024 (https://vizhub.healthdata.org/gbd-results/). Accessed July 10, 2025.
4. World Health Organisation. Obesity and overweight. Geneva WHO. 2025. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight Accessed June 27, 2025.
5. Okunogbe A, Nugent R, Spencer G, Powis J, Ralston J, Wilding J. Economic impacts of overweight and obesity: current and future estimates for 161 countries. BMJ Glob Health. 2022; 7(9): e009773. https://pubmed.ncbi.nlm.nih.gov/36130777/ Accessed June 27, 2025.
6. Au-Yeung CL, Ellis D, Dallaway A, Riley J et al. Socioeconomic and ethnic inequalities increase the risk of type 2 diabetes: an analysis of NHS health check attendees in Birmingham. Front. Public Health. 2024; 12. https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1477418/full Accessed June 22, 2025.
7. Choi D-W, Lee SA, Lee DW, Joo JH et al. Effect of socioeconomic deprivation on outcomes of diabetes complications in patients with type 2 diabetes mellitus: a nationwide population-based cohort study of South Korea. BMJ Open Diabetes Research & Care. 2020; 8: e000729. https://drc.bmj.com/content/8/1/e000729?__cf_chl_rt_tk=gNKh30iL9r1CEK61.qz8RAeNZeCUw28GBvH5leFK1Ww-1750192871-1.0.1.1-vUHdl3Kzu57ofGaOb4U3tKUCjKTckAK6DXxvh2Wn_3g#sec-9 Accessed June 22, 2025.
8. Grundmann N, Mielck A, Siegel M et al. Area deprivation and the prevalence of type 2 diabetes and obesity: analysis at the municipality level in Germany. BMC Public Health. 2014; 14:1264. https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-1264#citeas Accessed June 22, 2025.
9. International Diabetes Federation. United Kingdom. Diabetes country report 2000-2050. 2025. https://diabetesatlas.org/data-by-location/country/united-kingdom/ Accessed July 10, 2025.
10. Overweight (including obesity) prevalence in adults, (using adjusted self-reported height and weight) (18+ yrs). Proportion - % https://fingertips.phe.org.uk/search/Overweight%20and%20obesity#page/4/gid/1938133368/pat/159/par/K02000001/ati/15/are/E92000001/iid/93088/age/168/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1 Accessed July 10, 2025.
11. Public Health Profiles. Obesity prevalence in adults, (using adjusted self-reported height and weight (18+). Proportion (percent). 2025. https://fingertips.phe.org.uk/search/Obesity#page/3/gid/1938133152/pat/10146/par/cat-146-1/ati/402/iid/93881/age/168/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1 Accessed June 7, 2025.
12. Folkhalsomyndigheten. Public health data. Diabetes by sex,region and year (4-year averages). Proportion(percent).2025. https://fohm-app.folkhalsomyndigheten.se/Folkhalsodata/pxweb/sv/A_Folkhalsodata/A_Folkhalsodata__Z_ovrigdata__HLVkn__Hals/diabet.px/ Accessed June 6, 2025.
13. International Diabetes Federation. Sweden. Diabetes country report 2000-2050.2025. https://diabetesatlas.org/data-by-location/country/sweden/ Accessed June 23, 2025.
14. Agardh EE, Sidorchuk A, Hallqvist J, Ljung R. Burden of type 2 diabetes attributed to lower educational levels in Sweden. Population Health Metrics. 2011; 9:60. file:///C:/Users/HP/Downloads/1478-7954-9-60.pdf Accessed June 23, 2025.
15. Public Health Profiles. Deprivation score. 2025. https://fingertips.phe.org.uk/search/Deprivation%20score%202019#page/3/gid/1/pat/10160/ati/502/are/E09000002/iid/93553/age/1/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1 Accessed June 7, 2025.
16. Public Health Profiles. Percentage of adults meeting the “5-a-day” fruit and vegetable consumption recommendations. Proportion (percent). 2025. https://fingertips.phe.org.uk/search/Percentage%20of%20adults%20meeting%20the%205%20a%20day%20fruit%20and%20vegetable%20consumption%20recommendations#page/3/gid/1/pat/10160/par/cat-160-1/ati/502/iid/93982/age/164/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1 Accessed June 7, 2025.
17. Public Health Profiles. Diabetes: QOF prevalence. 2025. https://fingertips.phe.org.uk/search/Diabetes%20QOF%20prevalence#page/3/gid/1/pat/10146/ati/402/are/E09000006/iid/241/age/187/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1 Accessed June 7, 2025.
18. Saunders MNK, Lewis P, Thornhill A. Research Methods for Business Students. Eighth edition. New York. Pearson Education Limited. 2019. 12: 564-636. Accessed July 7, 2025.
19. Bruce N, Pope D, Stanistreet D. Quantitative methods for health research. A Practical Interactive Guide to Epidemiology and Statistics. Chichester: Wiley-Blackwell. c2008. https://www.vlereader.com/Reader?ean=9780470022764 Accessed July 4, 2025.
20. Folkhalsomyndigheten. Public health data. Overweight and obesity by BMI, disposable income, gender and year. Proportion (percent). 2025.Available from: https://fohm-app.folkhalsomyndigheten.se/Folkhalsodata/pxweb/sv/A_Folkhalsodata/A_Folkhalsodata__Z_ovrigdata__Vikt%20(BMI)__ViktULF/BMIULFink.px/table/tableViewLayout1/ Accessed June 6, 2025.
21. Folkhalsomyndigheten. Public health data. Overweight and obesity by socioeconomic area type, sex and year. Proportion (percentage).2025. https://fohm-app.folkhalsomyndigheten.se/Folkhalsodata/pxweb/sv/A_Folkhalsodata/A_Folkhalsodata__A_Mo8__Halsoutfall__09Riskfakt__09.01overfet/overfettyp.px/table/tableViewLayout1/ Accessed June 6, 2025.
22. Folkhalsomyndigheten. Public health data. Vegetable and root vegetable intake by household income, gender and year. Share (percent).2025. https://fohm-app.folkhalsomyndigheten.se/Folkhalsodata/pxweb/sv/A_Folkhalsodata/A_Folkhalsodata__A_Mo8__6_Levanor__02Okad__06.22gronsakdag/gronsakdagbeko.px/table/tableViewLayout1/ Accessed June 6, 2025.
23. Folkhalsomyndigheten. Public health data. Vegetable and root vegetable intake by socioeconomic area type, gender and year. Proportion (percent).2025. https://fohm-app.folkhalsomyndigheten.se/Folkhalsodata/pxweb/sv/A_Folkhalsodata/A_Folkhalsodata__A_Mo8__6_Levanor__02Okad__06.22gronsakdag/gronsakdagtyp.px/table/tableViewLayout1/ Accessed June 6, 2025.
24. Folkhalsomyndigheten. Public health data. Economic Standard by gender, region and year. Thousands of kronor. 2025.
https://fohm-app.folkhalsomyndigheten.se/Folkhalsodata/pxweb/sv/A_Folkhalsodata/A_Folkhalsodata__A_Mo8__4_Inkomst__01Fordelink__04.01Dink/DinkReg.px/ Accessed June 6, 2025.
25. Public Health Profiles. Indicator Definitions and Supporting Information. 2025. https://fingertips.phe.org.uk/search/Diabetes%20QOF%20prevalence#page/6/gid/1/pat/15/par/E92000001/ati/502/are/E09000002/iid/241/age/187/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1 Accessed June 22, 2025.
26. Fruit and vegetable intake by gender, region and year (4-year averages) 2021-2024. Proportion(percent). https://fohm-app.folkhalsomyndigheten.se/Folkhalsodata/pxweb/sv/A_Folkhalsodata/A_Folkhalsodata__Z_ovrigdata__HLVkn__Mat/fruktgront.px/ Accessed July 1, 2025.
27. Ball K, Lamb KE, Costa C, Cutumisu N et al. Neighbourhood socioeconomic disadvantage and fruit and vegetable consumption: a seven countries comparison. Int J Behav Nutr Phys Act. 2015; 12: 68. https://link.springer.com/article/10.1186/s12966-015-0229-x#Sec8 Accessed June 30, 2025.
28. Fu L, Shi Y, Li S et al. Healthy Diet-Related Knowledge, Attitude, and Practice (KAP) and Related Socio-Demographic Characteristics among Middle-Aged and Older Adults: A Cross-Sectional Survey in Southwest China. Nutrients. 2024;16(6): 869. https://pmc.ncbi.nlm.nih.gov/articles/PMC10974890/#sec4-nutrients-16-00869 Accessed July 11, 2025.
29. Prentice AM, Jebb SA. Fast foods, energy density and obesity: a possible mechanistic link. Obes Rev. 2003; 4(4):187-94. https://pubmed.ncbi.nlm.nih.gov/14649369/ Accessed July 3, 2025.
30. Krishnaswamy K & Gayathri R. Nature's bountiful gift to humankind: Vegetables & fruits & their role in cardiovascular disease & diabetes. Indian Journal of Medical Research. 2018; 148(5): 569-595. https://journals.lww.com/ijmr/fulltext/2018/48050/nature_s_bountiful_gift_to_humankind__vegetables__.13.aspx Accessed June 27, 2025.
31. Mente A, Dehghan M, Rangarajan S, O'Donnell M, et al. Diet, cardiovascular disease, and mortality in 80 countries. Eur Heart J. 2023; 44(28): 2560-2579. https://pmc.ncbi.nlm.nih.gov/articles/PMC10361015/#abstract1 Accessed July 3, 2025.
32. World Health Organization. Increasing fruit and vegetable consumption to reduce the risk of non-communicable diseases. e-Library of Evidence for Nutrition Actions (eLENA). Geneva WHO.2023. https://www.who.int/tools/elena/interventions/fruit-vegetables-ncds Accessed June 28, 2025.
33. Li M, Fan Y, Zhang X, Hou W et al. Fruit and vegetable intake and risk of type 2 diabetes mellitus: meta-analysis of prospective cohort studies. BMJ Open. 2014; 4: e005497. https://bmjopen.bmj.com/content/4/11/e005497.long Accessed June 28, 2025.
34. Andreeva D, Bednarek P, Cera K, Daly P et al. European Central Bank. Financial Stability Review. https://www.ecb.europa.eu/press/financial-stability-publications/fsr/html/ecb.fsr202505~0cde5244f6.en.html#toc2 Accessed June 30, 2025.
35. The World Bank. FAO Statistics Division. Food Insecurity Experience Scale 2022. Sweden, 2022. file:///C:/Users/HP/Downloads/ddi-documentation-english_microdata-6063.pdf Accessed June 30, 2025.
36. The World Bank. FAO Statistics Division. Food Insecurity Experience Scale 2023. Sweden, 2023. file:///C:/Users/HP/Downloads/ddi-documentation-english_microdata-6334.pdf Accessed June 30, 2025.
37. The World Bank. FAO Statistics Division. Food Insecurity Experience Scale 2022. United Kingdom, 2023. file:///C:/Users/HP/Downloads/ddi-documentation-english_microdata-6026.pdf Accessed June 30, 2025.
38. The World Bank. FAO Statistics Division. Food Insecurity Experience Scale 2023.United Kingdom, 2023. file:///C:/Users/HP/Downloads/ddi-documentation-english_microdata-6304.pdf Accessed June 30, 2025.
39. Bonita R, Beaglehole R, Kiellstrom T. Basic Epidemiology. Geneva: WHO Press. c2012. https://rl.talis.com/3/essex/lists/FEE24BB6-E10B-385C-1484-AAB365FA5EBC.html?lang=en-GB Accessed July 11, 2025.
40. Pop B, Fetica B, Blaga ML, et al. The role of medical registries, potential applications and limitations. Med Pharm Rep. 2019; 92(1): 7-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448488/ Accessed July 8, 2025.
41. Thygesen L.G, Ersboll A.K. When the entire population is the sample: strengths and limitations in register-based epidemiology. Eur J Epidemiol 2014; 29(8): 551-558. http://www.jstor.org/stable/43775005 Accessed July 6, 2025.
42. Lim CY, In J. Randomization in clinical studies. Korean J Anesthesiol. 2019; 72(3): 221-232. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547231/ Accessed July 3, 2025.
43. Mooney SJ, Westreich DJ, El-Sayed AM. Epidemiology in the Era of Big Data. Epidemiology. 2015; 26(3): 390-394. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4385465/ Accessed July 9, 2025.
44. Green J, Tones K, Cross R., et al. Health Promotion: Planning and Strategies. Edition: 4th. London: SAGE. c2019. https://online.vitalsource.com/#/books/9781526470980/cfi/6/30!/4/2/4/2@0:0 Accessed July 8, 2025.
45. Hill-Briggs F, Adler NE, Berkowitz SA, Chin MH et al. Social determinants of health and diabetes: a scientific review. Diabetes Care. 2020; 44: 258-79. https://diabetesjournals.org/care/article/44/1/258/33180/Social-Determinants-of-Health-and-Diabetes-A#3283076 Accessed July 11, 2025.