Health inequality related to non-communicable diseases remains relevant across various socio-economic strata. Research indicates that individuals with low socio-economic status (SES) are at higher risk of mortality from metabolic syndrome, type 2 diabetes, and cardiovascular diseases. Limited access to medical resources, chronic stress, unhealthy lifestyles, and exposure to pollutants all contribute to the adverse health outcomes associated with low SES.
Diabetes mellitus is one of the fastest-growing chronic diseases worldwide. In 2013, 382 million people globally had diabetes. Currently, this figure stands at approximately 422 million, and it is projected to rise to 592 million by 2035. Annually, the disease incurs significant healthcare costs and leads to millions of premature deaths due to complications.
About three out of four individuals with diabetes currently reside in low- and middle-income countries (LMICs), where the rate of diabetes prevalence over the past twenty years has surpassed that of high-income countries [3].
Research conducted by an international team in 29 LMICs (predominantly African countries) shows that the prevalence of diabetes among people over 25 years old is 7.5%, with most cases being undiagnosed. It was also found that the prevalence of diabetes increases with the country’s income level. Furthermore, higher education was associated with a greater risk of diabetes regardless of income level. This result remained statistically significant even after adjusting for other risk factors such as body mass index (BMI). It suggests that the higher risk of diabetes among those with higher education is not solely related to higher BMI [3], indicating other factors that need further study.
However, attention should be paid not only to LMICs but also to high-income countries, where socio-economic differentiation is observed. For example, in the Netherlands, a large prospective study involving 167,729 people in the northern part of the country examined the impact of education and income levels on the incidence of type 2 diabetes and cardiovascular diseases. The study included participants aged 30 to 65 who initially did not have diabetes or cardiovascular diseases.
It was found that low levels of education and income were independently associated with higher risks of type 2 diabetes and cardiovascular diseases. Participants with lower education levels had a 24% higher risk of developing diabetes and a 15% higher risk of cardiovascular diseases. Those with low income levels had a 71% higher risk of diabetes and a 24% higher risk of cardiovascular diseases [2].
Similar trends are observed in Canada, where the prevalence of diabetes has significantly increased in recent decades. A study based on data from the Canadian Community Health Survey (CCHS) from 2000 to 2008 in the province of Saskatchewan found that among individuals with an annual income of less than $29,999, 9% had diabetes, compared to 4.3% of those earning $30,000 to $79,999 and only 2.7% of those with an income over $80,000. Additionally, low income was associated with an increased risk of high blood pressure, obesity, and physical inactivity [1].
These findings underscore the importance of considering education and income as separate indicators that can affect health through different mechanisms.
Education provides intangible resources such as knowledge and skills that help better understand and apply health information. Individuals with lower education levels often have less access to information about a healthy lifestyle, are less likely to engage in regular physical activity, and maintain a balanced diet, which increases the risk of developing diabetes.
Income reflects the material resources necessary for healthy eating, access to medical services, and other healthy habits. If a person has a low income, their ability to afford expensive treatment and consume higher-quality products decreases. Therefore, considering these two socio-economic factors is crucial for developing and improving effective public programs and policies to reduce health inequalities.
Sources:
- Bird, Y., Lemstra, M., Rogers, M., & Moraros, J. (2015, October 12). The relationship between socioeconomic status/income and prevalence of diabetes and associated conditions: A cross-sectional population-based study in Saskatchewan, Canada. International journal for equity in health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603875/
- Duan, M.-J. F., et al. (2022, November). Effects of education and income on incident type 2 diabetes and cardiovascular diseases: A Dutch prospective study. Journal of general internal medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9640500/#:~:text=Low%20education%20and%20low%20income
- Seiglie, J. A., et al. (2020, April). Diabetes prevalence and its relationship with education, wealth, and BMI in 29 low- and middle-income countries. Diabetes care. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7085810/