Intersectional analysis of social disparities in type 2 diabetes risk among adults in Germany: results from a nationwide population-based survey
Abstract Background Differences in type 2 diabetes risk have been reported for several sociodemographic determinants including sex/gender or socioeconomic status. From an intersectional perspective, it is important to not only consider the role of social dimensions individually, but also their inter...
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| Format: | Article |
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BMC
2024-02-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-024-17903-5 |
| _version_ | 1797272874844684288 |
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| author | Francesca Färber Enrique Alonso-Perez Christin Heidemann Yong Du Gertraud Stadler Paul Gellert Julie Lorraine O’Sullivan |
| author_facet | Francesca Färber Enrique Alonso-Perez Christin Heidemann Yong Du Gertraud Stadler Paul Gellert Julie Lorraine O’Sullivan |
| author_sort | Francesca Färber |
| collection | DOAJ |
| description | Abstract Background Differences in type 2 diabetes risk have been reported for several sociodemographic determinants including sex/gender or socioeconomic status. From an intersectional perspective, it is important to not only consider the role of social dimensions individually, but also their intersections. This allows for a deeper understanding of diabetes risk and preventive needs among diverse population groups. Methods As an intersectionality-informed approach, multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was used in a population-based sample of adults without known diabetes in Germany from the cross-sectional survey “Disease knowledge and information needs– Diabetes mellitus (2017)”. Diabetes risk was assessed by the German Diabetes Risk Score (GDRS, range 0-122 points), estimating the individual risk of developing type 2 diabetes within the next 5 years based on established self-reported risk factors. Nesting individuals in 12 intersectional strata defined by combining sex/gender, educational level, and history of migration, we calculated measures to quantify the extent to which individual differences in diabetes risk were explained at strata level, and how much this was due to additive or multiplicative intersectional effects of social determinants. Results Drawing on data of 2,253 participants, we found good discriminatory accuracy of intersectional strata (variance partition coefficient = 14.00% in the simple intersectional model). Model-predicted GDRS means varied between 29.97 (corresponding to a “low risk” of < 2%) in women with high educational level and a history of migration, and 52.73 (“still low risk” of 2–5%) in men with low educational level without a history of migration. Variance in GDRS between strata was mainly explained by additive effects of social determinants (proportional change in variance to intersectional interaction model = 77.95%) with being male and having low educational level being associated with higher GDRS. There was no evidence of multiplicative effects in individual strata. Conclusions Type 2 diabetes risk differed between intersectional strata and can to some extent be explained at strata level. The role of intersectional effects was minor and needs to be further investigated. Findings suggest a need for specific preventive measures targeted at large groups with increased diabetes risk, such as men and persons with low educational level. |
| first_indexed | 2024-03-07T14:35:33Z |
| format | Article |
| id | doaj.art-12fca36cae1042fda0601dd2ad793939 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-03-07T14:35:33Z |
| publishDate | 2024-02-01 |
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| series | BMC Public Health |
| spelling | doaj.art-12fca36cae1042fda0601dd2ad7939392024-03-05T20:38:11ZengBMCBMC Public Health1471-24582024-02-0124111210.1186/s12889-024-17903-5Intersectional analysis of social disparities in type 2 diabetes risk among adults in Germany: results from a nationwide population-based surveyFrancesca Färber0Enrique Alonso-Perez1Christin Heidemann2Yong Du3Gertraud Stadler4Paul Gellert5Julie Lorraine O’Sullivan6Institute of Medical Sociology and Rehabilitation Science, Charité– Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu BerlinInstitute of Medical Sociology and Rehabilitation Science, Charité– Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu BerlinDepartment of Epidemiology and Health Monitoring, Robert Koch InstituteDepartment of Epidemiology and Health Monitoring, Robert Koch InstituteInstitute of Gender in Medicine (GiM), Charité– Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu BerlinInstitute of Medical Sociology and Rehabilitation Science, Charité– Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu BerlinInstitute of Medical Sociology and Rehabilitation Science, Charité– Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu BerlinAbstract Background Differences in type 2 diabetes risk have been reported for several sociodemographic determinants including sex/gender or socioeconomic status. From an intersectional perspective, it is important to not only consider the role of social dimensions individually, but also their intersections. This allows for a deeper understanding of diabetes risk and preventive needs among diverse population groups. Methods As an intersectionality-informed approach, multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was used in a population-based sample of adults without known diabetes in Germany from the cross-sectional survey “Disease knowledge and information needs– Diabetes mellitus (2017)”. Diabetes risk was assessed by the German Diabetes Risk Score (GDRS, range 0-122 points), estimating the individual risk of developing type 2 diabetes within the next 5 years based on established self-reported risk factors. Nesting individuals in 12 intersectional strata defined by combining sex/gender, educational level, and history of migration, we calculated measures to quantify the extent to which individual differences in diabetes risk were explained at strata level, and how much this was due to additive or multiplicative intersectional effects of social determinants. Results Drawing on data of 2,253 participants, we found good discriminatory accuracy of intersectional strata (variance partition coefficient = 14.00% in the simple intersectional model). Model-predicted GDRS means varied between 29.97 (corresponding to a “low risk” of < 2%) in women with high educational level and a history of migration, and 52.73 (“still low risk” of 2–5%) in men with low educational level without a history of migration. Variance in GDRS between strata was mainly explained by additive effects of social determinants (proportional change in variance to intersectional interaction model = 77.95%) with being male and having low educational level being associated with higher GDRS. There was no evidence of multiplicative effects in individual strata. Conclusions Type 2 diabetes risk differed between intersectional strata and can to some extent be explained at strata level. The role of intersectional effects was minor and needs to be further investigated. Findings suggest a need for specific preventive measures targeted at large groups with increased diabetes risk, such as men and persons with low educational level.https://doi.org/10.1186/s12889-024-17903-5Diabetes mellitusDiabetes riskPreventionIntersectionalitySocial determinantsPopulation-based survey |
| spellingShingle | Francesca Färber Enrique Alonso-Perez Christin Heidemann Yong Du Gertraud Stadler Paul Gellert Julie Lorraine O’Sullivan Intersectional analysis of social disparities in type 2 diabetes risk among adults in Germany: results from a nationwide population-based survey BMC Public Health Diabetes mellitus Diabetes risk Prevention Intersectionality Social determinants Population-based survey |
| title | Intersectional analysis of social disparities in type 2 diabetes risk among adults in Germany: results from a nationwide population-based survey |
| title_full | Intersectional analysis of social disparities in type 2 diabetes risk among adults in Germany: results from a nationwide population-based survey |
| title_fullStr | Intersectional analysis of social disparities in type 2 diabetes risk among adults in Germany: results from a nationwide population-based survey |
| title_full_unstemmed | Intersectional analysis of social disparities in type 2 diabetes risk among adults in Germany: results from a nationwide population-based survey |
| title_short | Intersectional analysis of social disparities in type 2 diabetes risk among adults in Germany: results from a nationwide population-based survey |
| title_sort | intersectional analysis of social disparities in type 2 diabetes risk among adults in germany results from a nationwide population based survey |
| topic | Diabetes mellitus Diabetes risk Prevention Intersectionality Social determinants Population-based survey |
| url | https://doi.org/10.1186/s12889-024-17903-5 |
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