Self-reported diabetes mellitus in older population and health inequalities in Europe

Introduction

Diabetes mellitus (DM) has been a major health concern with increased epidemiologic and economic burden in Europe. The research aims to estimate self-reported DM prevalence and inequalities in older individuals aged 50 years and over in 13 European countries at their national and subnational level between 2010 and 2019.

Methods

Microdata were extracted from waves 4 to wave 8 of the Survey of Health, Ageing and Retirement in Europe (SHARE) database. Health inequalities of DM were assessed using the Gini Coefficient (GC) and Concentration Index (CI). Socioeconomic risk factors were included in the inequality analysis (urbanization, income, and educational level). Multilevel regression model was also conducted.

Results

The pooled prevalence of DM has decreased from 11% to 10.6% between waves 4 and 8. The highest was observed in Czechia 16.7% (95%CI:13.1–20.2) in wave 8, while lowest was found in wave 5 in Switzerland 5.9% (95%CI:5.0-6.8). DM prevalence varied widely subnationally ranging from 2.1% (95% CI:0.3–3.8) in Zentralschweiz (Switzerland) to 28.5% (95%CI:0.3–56.7) in Střední Čechy (Czechia), both in wave 8. The GC demonstrated an increase reaching 22.5% (95%CI:19.4-25.2) in 2019. The CI of income was similar to educational level as it was negative and statistically significant. The results of multilevel analysis showed increased odds of DM in later waves compared to the reference wave 4.

Conclusions

The finding suggests that despite a slight decline in overall prevalence, increasing adjusted odds indicate the underlying risk of self-reported DM may not have decreased. Inequalities exist in DM both nationally and subnationally, with elevated rates observed among individuals with lower educational and income levels. Addressing these significant health inequalities calls for the development of prevention programs and policies by the European countries and subnational regions, specifically tailored to prioritize and support vulnerable groups.

Key messages

• Diabetes prevalence has slightly declined overall, but inequalities varied across EU regions and socioeconomic groups.

• Lower income and education are associated with greater burden of diabetes, indicating the need for targeted socioeconomic interventions.