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Socio-economic status

there is an association with reduced risk as the level of income, education and occupation status...

There are three key areas of SES – Income, Education & Occupation. In each of these areas there is an association with reduced risk as the level of income, education and occupation status increases (in more economically developed countries rather than lower to middle income countries).

These factors impact access to housing, transportation, nutritious food and healthcare. It can also impact access to social resource including political power, social engagement and control (Hill-Briggs, et al., 2021) The US National Interview Survey (NHIS – 2011-2014 was analysed and there was continual increasing diabetes prevalence in income levels.

The percentage difference from high income to poor was 100.4% and in the US it is noted there are widening disparities in diabetes prevalence compared with income compared to previous studies in 1999-2002 (Beckles & Chou, 2016). The same trends follow in education with higher levels of education associated with lower incidence of T2DM (CDC, 2017).

The reasons for the findings with income are 33-50% associated with modifiable T2DM factors including obesity, diet, physical activity and alcohol intake and other factors be related to other stress related factors including hopelessness, reduced autonomy. Other factors include lack of healthy food access, exercise facilities and health services (Bonilla, Rodriguez-Gutierrez, & Montori, 2016; Volaco, Cavalcanti, & Precoma, 2018).

Understanding the impact of employment is not straightforward. Unemployment increases the risk of prediabetes (OR 1.58, 95% CI 1.07-2.35) and T2DM (OR 1.72, 95% CI 1.14-2.58) results from a meta-analysis (Varanka-Ruuska, Rautio, & Lehtiniemi, 2018).

Shift-work rather than normal working times is associated with a higher risk (Gan, Yang, & Tong, 2015). Long work hours of ≥55 hours per week is associated with higher levels of T2DM in low SES but not high SES (Kivimaki, Virtanen, Kawachi, & al, 2015).



Beckles, G. L., & Chou, C. F. (2016). Disparities in the prevalence of diagnosed diabetes—United States, 1999–2002 and 2011–2014. Morbidity and Mortality Weekly Report, 65, 1265-1269.

Bonilla, G. S., Rodriguez-Gutierrez, R., & Montori, V. M. (2016). What we don’t talk about when we talk about preventing type 2 diabetes—addressing socioeconomic disadvantage. JAMA internal medicine, 176(8), 1053-1054.

CDC. (2017). National Diabetes Statistics Report, 2017. Atlanta, GA. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services. Retrieved from , Centers for Disease Control and Prevention, US Department of Health and Human Services, 2017. Accessed 25 October 2020.

Gan, Y., Yang, C., & Tong, X. e. (2015). Shift work and diabetes mellitus: a meta-analysis of observational studies.  . Occupation and Environmental Medicine , 72(1), 72-78.

Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., . . . Haire-Joshu, D. (2021). Social determinants of health and diabetes: a scientific review. Diabetes care, 44(1), 258-279.

Kivimaki, M., Virtanen, M., Kawachi, I., & al, e. (2015). Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222 120 individuals. . Lancet Journal of Diabetes and Endocrinology , 3, 27-34.

Varanka-Ruuska, T., Rautio, N., & Lehtiniemi, H. (2018). The association of unemployment with glucose metabolism: a systematic review and meta-analysis. International Journal of Public Health, 63, 435–446.

Volaco, A., Cavalcanti, A. M., & Precoma, D. B. (2018). Socioeconomic status: the missing link between obesity and diabetes mellitus? Current diabetes reviews, 14(4), 321-326.

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