Lower educational level is a predictor of incident type 2 diabetes in European countries: The EPIC-interact study

Carlotta Sacerdote; Fulvio Ricceri; Olov Rolandsson; Ileana Baldi; Maria Dolores Chirlaque; Edith Feskens; Benedetta Bendinelli; Eva Ardanaz; Larraitz Arriola; Beverley Balkau; Manuela Bergmann; Joline WJ Beulens; Heiner Boeing; Françoise Clavel-Chapelon; Francesca Crowe; Blandine de Lauzon-Guillain; Nita Forouhi; Paul W. Franks; Valentina Gallo; Carlos Gonzalez; Jytte Halkjær; Anne Kathrin Illner; Rudolf Kaaks; Timothy Key; Kay Tee Khaw; Carmen Navarro; Peter M. Nilsson; Susanne Oksbjerg Dalton; Kim Overvad; Valeria Pala; Domenico Palli; Salvatore Panico; Silvia Polidoro; J. Ramón Quirós; Isabelle Romieu; María José Sánchez; Nadia Slimani; Ivonne Sluijs; Annemieke Spijkerman; Birgit Teucher; Anne Tjønneland; Rosario Tumino; A. Daphne van der; Anne Claire Vergnaud; Patrik Wennberg; Stephen Sharp; Claudia Langenberg; Elio Riboli; Paolo Vineis; Nicholas Wareham

doi:10.1093/ije/dys091

Lower educational level is a predictor of incident type 2 diabetes in European countries: The EPIC-interact study

Carlotta Sacerdote, Fulvio Ricceri, Olov Rolandsson, Ileana Baldi, Maria Dolores Chirlaque, Edith Feskens, Benedetta Bendinelli, Eva Ardanaz, Larraitz Arriola, Beverley Balkau, Manuela Bergmann, Joline WJ Beulens, Heiner Boeing, Françoise Clavel-Chapelon, Francesca Crowe, Blandine de Lauzon-Guillain, Nita Forouhi, Paul W. Franks, Valentina Gallo, Carlos GonzalezJytte Halkjær, Anne Kathrin Illner, Rudolf Kaaks, Timothy Key, Kay Tee Khaw, Carmen Navarro, Peter M. Nilsson, Susanne Oksbjerg Dalton, Kim Overvad, Valeria Pala, Domenico Palli, Salvatore Panico, Silvia Polidoro, J. Ramón Quirós, Isabelle Romieu, María José Sánchez, Nadia Slimani, Ivonne Sluijs, Annemieke Spijkerman, Birgit Teucher, Anne Tjønneland, Rosario Tumino, A. Daphne van der, Anne Claire Vergnaud, Patrik Wennberg, Stephen Sharp, Claudia Langenberg, Elio Riboli, Paolo Vineis, Nicholas Wareham

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide. In high-income countries, low socioeconomic status seems to be related to a high incidence of T2DM, but very little is known about the intermediate factors of this relationship. Method: We performed a case-cohort study in eight Western European countries nested in the EPIC study (n = 340 234, 3.99 million person-years of follow-up). A random sub-cohort of 16 835 individuals and a total of 12 403 incident cases of T2DM were identified. Crude and multivariate-adjusted hazard ratios (HR) were estimated for each country and pooled across countries using meta-analytical methods. Age-, gender- and country-specific relative indices of inequality (RII) were used as the measure of educational level and RII tertiles were analysed. Results: Compared with participants with a high educational level (RII tertile 1), participants with a low educational level (RII tertile 3) had a higher risk of T2DM [HR: 1.77, 95% confidence interval (CI): 1.69-1.85; P-trend < 0.01]. The HRs adjusted for physical activity, smoking status and propensity score according to macronutrient intake were very similar to the crude HR (adjusted HR: 1.67, 95% CI: 1.52-1.83 in men; HR: 1.88, 95% CI: 1.73-2.05 in women). The HRs were attenuated only when they were further adjusted for BMI (BMI-adjusted HR: 1.36, 95% CI: 1.23-1.51 in men; HR: 1.32, 95% CI: 1.20-1.45 in women). Conclusion: This study demonstrates the inequalities in the risk of T2DM in Western European countries, with an inverse relationship between educational level and risk of T2DM that is only partially explained by variations in BMI. Published by Oxford University Press on behalf of the International Epidemiological Association

Original language	English
Article number	dys091
Pages (from-to)	1162-1173
Number of pages	12
Journal	International Journal of Epidemiology
Volume	41
Issue number	4
DOIs	https://doi.org/10.1093/ije/dys091
Publication status	Published - Aug 2012
Externally published	Yes

Keywords

Cohort studies
Education
Epidemiologic research design
Relative index of inequality
Socio-economic status
T2DM

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/ije/dys091

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Sacerdote, C., Ricceri, F., Rolandsson, O., Baldi, I., Chirlaque, M. D., Feskens, E., Bendinelli, B., Ardanaz, E., Arriola, L., Balkau, B., Bergmann, M., Beulens, J. WJ., Boeing, H., Clavel-Chapelon, F., Crowe, F., de Lauzon-Guillain, B., Forouhi, N., Franks, P. W., Gallo, V., ... Wareham, N. (2012). Lower educational level is a predictor of incident type 2 diabetes in European countries: The EPIC-interact study. International Journal of Epidemiology, 41(4), 1162-1173. Article dys091. https://doi.org/10.1093/ije/dys091

@article{61da99f118bd48d48484f653c5dda411,

title = "Lower educational level is a predictor of incident type 2 diabetes in European countries: The EPIC-interact study",

abstract = "Background: Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide. In high-income countries, low socioeconomic status seems to be related to a high incidence of T2DM, but very little is known about the intermediate factors of this relationship. Method: We performed a case-cohort study in eight Western European countries nested in the EPIC study (n = 340 234, 3.99 million person-years of follow-up). A random sub-cohort of 16 835 individuals and a total of 12 403 incident cases of T2DM were identified. Crude and multivariate-adjusted hazard ratios (HR) were estimated for each country and pooled across countries using meta-analytical methods. Age-, gender- and country-specific relative indices of inequality (RII) were used as the measure of educational level and RII tertiles were analysed. Results: Compared with participants with a high educational level (RII tertile 1), participants with a low educational level (RII tertile 3) had a higher risk of T2DM [HR: 1.77, 95% confidence interval (CI): 1.69-1.85; P-trend < 0.01]. The HRs adjusted for physical activity, smoking status and propensity score according to macronutrient intake were very similar to the crude HR (adjusted HR: 1.67, 95% CI: 1.52-1.83 in men; HR: 1.88, 95% CI: 1.73-2.05 in women). The HRs were attenuated only when they were further adjusted for BMI (BMI-adjusted HR: 1.36, 95% CI: 1.23-1.51 in men; HR: 1.32, 95% CI: 1.20-1.45 in women). Conclusion: This study demonstrates the inequalities in the risk of T2DM in Western European countries, with an inverse relationship between educational level and risk of T2DM that is only partially explained by variations in BMI. Published by Oxford University Press on behalf of the International Epidemiological Association",

keywords = "Cohort studies, Education, Epidemiologic research design, Relative index of inequality, Socio-economic status, T2DM",

author = "Carlotta Sacerdote and Fulvio Ricceri and Olov Rolandsson and Ileana Baldi and Chirlaque, {Maria Dolores} and Edith Feskens and Benedetta Bendinelli and Eva Ardanaz and Larraitz Arriola and Beverley Balkau and Manuela Bergmann and Beulens, {Joline WJ} and Heiner Boeing and Fran{\c c}oise Clavel-Chapelon and Francesca Crowe and {de Lauzon-Guillain}, Blandine and Nita Forouhi and Franks, {Paul W.} and Valentina Gallo and Carlos Gonzalez and Jytte Halkj{\ae}r and Illner, {Anne Kathrin} and Rudolf Kaaks and Timothy Key and Khaw, {Kay Tee} and Carmen Navarro and Nilsson, {Peter M.} and Dalton, {Susanne Oksbjerg} and Kim Overvad and Valeria Pala and Domenico Palli and Salvatore Panico and Silvia Polidoro and Quir{\'o}s, {J. Ram{\'o}n} and Isabelle Romieu and S{\'a}nchez, {Mar{\'i}a Jos{\'e}} and Nadia Slimani and Ivonne Sluijs and Annemieke Spijkerman and Birgit Teucher and Anne Tj{\o}nneland and Rosario Tumino and {van der}, {A. Daphne} and Vergnaud, {Anne Claire} and Patrik Wennberg and Stephen Sharp and Claudia Langenberg and Elio Riboli and Paolo Vineis and Nicholas Wareham",

year = "2012",

month = aug,

doi = "10.1093/ije/dys091",

language = "English",

volume = "41",

pages = "1162--1173",

journal = "International Journal of Epidemiology",

issn = "0300-5771",

publisher = "Oxford University Press",

number = "4",

}

Sacerdote, C, Ricceri, F, Rolandsson, O, Baldi, I, Chirlaque, MD, Feskens, E, Bendinelli, B, Ardanaz, E, Arriola, L, Balkau, B, Bergmann, M, Beulens, JWJ, Boeing, H, Clavel-Chapelon, F, Crowe, F, de Lauzon-Guillain, B, Forouhi, N, Franks, PW, Gallo, V, Gonzalez, C, Halkjær, J, Illner, AK, Kaaks, R, Key, T, Khaw, KT, Navarro, C, Nilsson, PM, Dalton, SO, Overvad, K, Pala, V, Palli, D, Panico, S, Polidoro, S, Quirós, JR, Romieu, I, Sánchez, MJ, Slimani, N, Sluijs, I, Spijkerman, A, Teucher, B, Tjønneland, A, Tumino, R, van der, AD, Vergnaud, AC, Wennberg, P, Sharp, S, Langenberg, C, Riboli, E, Vineis, P & Wareham, N 2012, 'Lower educational level is a predictor of incident type 2 diabetes in European countries: The EPIC-interact study', International Journal of Epidemiology, vol. 41, no. 4, dys091, pp. 1162-1173. https://doi.org/10.1093/ije/dys091

TY - JOUR

T1 - Lower educational level is a predictor of incident type 2 diabetes in European countries

T2 - The EPIC-interact study

AU - Sacerdote, Carlotta

AU - Ricceri, Fulvio

AU - Rolandsson, Olov

AU - Baldi, Ileana

AU - Chirlaque, Maria Dolores

AU - Feskens, Edith

AU - Bendinelli, Benedetta

AU - Ardanaz, Eva

AU - Arriola, Larraitz

AU - Balkau, Beverley

AU - Bergmann, Manuela

AU - Beulens, Joline WJ

AU - Boeing, Heiner

AU - Clavel-Chapelon, Françoise

AU - Crowe, Francesca

AU - de Lauzon-Guillain, Blandine

AU - Forouhi, Nita

AU - Franks, Paul W.

AU - Gallo, Valentina

AU - Gonzalez, Carlos

AU - Halkjær, Jytte

AU - Illner, Anne Kathrin

AU - Kaaks, Rudolf

AU - Key, Timothy

AU - Khaw, Kay Tee

AU - Navarro, Carmen

AU - Nilsson, Peter M.

AU - Dalton, Susanne Oksbjerg

AU - Overvad, Kim

AU - Pala, Valeria

AU - Palli, Domenico

AU - Panico, Salvatore

AU - Polidoro, Silvia

AU - Quirós, J. Ramón

AU - Romieu, Isabelle

AU - Sánchez, María José

AU - Slimani, Nadia

AU - Sluijs, Ivonne

AU - Spijkerman, Annemieke

AU - Teucher, Birgit

AU - Tjønneland, Anne

AU - Tumino, Rosario

AU - van der, A. Daphne

AU - Vergnaud, Anne Claire

AU - Wennberg, Patrik

AU - Sharp, Stephen

AU - Langenberg, Claudia

AU - Riboli, Elio

AU - Vineis, Paolo

AU - Wareham, Nicholas

PY - 2012/8

Y1 - 2012/8

N2 - Background: Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide. In high-income countries, low socioeconomic status seems to be related to a high incidence of T2DM, but very little is known about the intermediate factors of this relationship. Method: We performed a case-cohort study in eight Western European countries nested in the EPIC study (n = 340 234, 3.99 million person-years of follow-up). A random sub-cohort of 16 835 individuals and a total of 12 403 incident cases of T2DM were identified. Crude and multivariate-adjusted hazard ratios (HR) were estimated for each country and pooled across countries using meta-analytical methods. Age-, gender- and country-specific relative indices of inequality (RII) were used as the measure of educational level and RII tertiles were analysed. Results: Compared with participants with a high educational level (RII tertile 1), participants with a low educational level (RII tertile 3) had a higher risk of T2DM [HR: 1.77, 95% confidence interval (CI): 1.69-1.85; P-trend < 0.01]. The HRs adjusted for physical activity, smoking status and propensity score according to macronutrient intake were very similar to the crude HR (adjusted HR: 1.67, 95% CI: 1.52-1.83 in men; HR: 1.88, 95% CI: 1.73-2.05 in women). The HRs were attenuated only when they were further adjusted for BMI (BMI-adjusted HR: 1.36, 95% CI: 1.23-1.51 in men; HR: 1.32, 95% CI: 1.20-1.45 in women). Conclusion: This study demonstrates the inequalities in the risk of T2DM in Western European countries, with an inverse relationship between educational level and risk of T2DM that is only partially explained by variations in BMI. Published by Oxford University Press on behalf of the International Epidemiological Association

AB - Background: Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide. In high-income countries, low socioeconomic status seems to be related to a high incidence of T2DM, but very little is known about the intermediate factors of this relationship. Method: We performed a case-cohort study in eight Western European countries nested in the EPIC study (n = 340 234, 3.99 million person-years of follow-up). A random sub-cohort of 16 835 individuals and a total of 12 403 incident cases of T2DM were identified. Crude and multivariate-adjusted hazard ratios (HR) were estimated for each country and pooled across countries using meta-analytical methods. Age-, gender- and country-specific relative indices of inequality (RII) were used as the measure of educational level and RII tertiles were analysed. Results: Compared with participants with a high educational level (RII tertile 1), participants with a low educational level (RII tertile 3) had a higher risk of T2DM [HR: 1.77, 95% confidence interval (CI): 1.69-1.85; P-trend < 0.01]. The HRs adjusted for physical activity, smoking status and propensity score according to macronutrient intake were very similar to the crude HR (adjusted HR: 1.67, 95% CI: 1.52-1.83 in men; HR: 1.88, 95% CI: 1.73-2.05 in women). The HRs were attenuated only when they were further adjusted for BMI (BMI-adjusted HR: 1.36, 95% CI: 1.23-1.51 in men; HR: 1.32, 95% CI: 1.20-1.45 in women). Conclusion: This study demonstrates the inequalities in the risk of T2DM in Western European countries, with an inverse relationship between educational level and risk of T2DM that is only partially explained by variations in BMI. Published by Oxford University Press on behalf of the International Epidemiological Association

KW - Cohort studies

KW - Education

KW - Epidemiologic research design

KW - Relative index of inequality

KW - Socio-economic status

KW - T2DM

UR - http://www.scopus.com/inward/record.url?scp=84865703223&partnerID=8YFLogxK

U2 - 10.1093/ije/dys091

DO - 10.1093/ije/dys091

M3 - Article

SN - 0300-5771

VL - 41

SP - 1162

EP - 1173

JO - International Journal of Epidemiology

JF - International Journal of Epidemiology

IS - 4

M1 - dys091

ER -

Lower educational level is a predictor of incident type 2 diabetes in European countries: The EPIC-interact study

Abstract

Keywords

UN SDGs

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