Socio-demographic & regional disparities in T2DM and diet quality in Europe: SHARE analysis

Background

Type 2 diabetes mellitus (T2DM) is a major health concern in Europe. Diet quality, influenced by socio-demographic factors, may affect T2DM risk. This study analysed socio-demographic, regional, and dietary factors associated with T2DM in older European adults.

Methods

Microdata of self-reported T2DM and diet quality were extracted from SHARE Wave 9 (2022–2023), including 19,426 adults in 27 countries, and were analysed cross-sectionally. Diet quality was based on a computed 0–12 score. Logistic regression assessed T2DM risk, and multivariate linear regression assessed diet quality, using BMI and sociodemographic factors.

Results

On one hand, T2DM risk decreased with lower BMI (underweight OR = 0.19, 95% CI: 0.11–0.32; obese as reference), but increased for males (OR = 1.44, 95% CI: 1.32–1.57), older age (OR = 4.19, 95% CI: 1.95–9.01; for 1930–49 births), no formal education (OR = 1.93, 95% CI: 1.55–2.41), retired (OR = 1.38, 95% CI: 1.23–1.55), and disabled (OR = 2.36, 95% CI: 1.86–2.99). Medium/high diet quality reduced odds (OR = 0.72, 95% CI: 0.66–0.79). On the other hand, diet quality scores were initially higher in Mediterranean regions, but this was reversed after adjustment (β= -0.415, 95% CI: -0.46 to -0.37). Males (β = 0.701, 95% CI: 0.657–0.746) and retired individuals (β = 0.024, 95% CI: 0.006–0.042) reported better diet quality, while higher education (β= -0.174, 95% CI: -0.199 to -0.149) and T2DM diagnosis (β = 0.254, 95% CI: 0.109–0.399) showed inverse links. BMI was not significant.

Conclusions

T2DM risk was strongly tied to socio-demographic and health factors, particularly BMI, age, gender, education, and employment status, rather than with broad regional differences. Diet quality was associated with lower odds of T2DM, but regional patterns did not straightforwardly correspond to lower T2DM prevalence. These findings highlight the need for equity-focused prevention strategies that address both behavioural and structural determinants of T2DM.

Key messages

• Lower BMI, higher diet quality, and education reduce T2DM risk in older Europeans, while being male, older, retired, or disabled increases it.

• Diet quality alone does not explain regional T2DM differences; socio-demographic factors like gender, education, and employment status play a stronger role.