Socioeconomic Inequalities in Type 2 Diabetes: Mediation Through Status Anxiety?

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  • Loes Crielaard
  • Ehsan Motazedi
  • Henrike Galenkamp
  • Herman G. van de Werfhorst
  • Rod, Naja Hulvej
  • Mirte A.G. Kuipers
  • Mary Nicolaou
  • Karien Stronks
Objectives: While status anxiety has received attention as a potential mechanism generating health inequalities, empirical evidence is still limited. Studies have been ecological and have largely focused on mental and not physical health outcomes.

Methods: We conducted individual-level analyses to assess status anxiety (feelings of inferiority resulting from social comparisons) and resources (financial difficulties) as mediators of the relationship between socioeconomic status (SES) (education/occupation/employment status) and type 2 diabetes (T2D). We used cross-sectional data of 21,150 participants (aged 18–70 years) from the Amsterdam-based HELIUS study. We estimated associations using logistic regression models and estimated mediated proportions using natural effect modelling.

Results: Odds of status anxiety were higher among participants with a low SES [e.g., OR = 2.66 (95% CI: 2.06–3.45) for elementary versus academic occupation]. Odds of T2D were 1.49 (95% CI: 1.12–1.97) times higher among participants experiencing status anxiety. Proportion of the SES–T2D relationship mediated was 3.2% (95% CI: 1.5%–7.0%) through status anxiety and 10.9% (95% CI: 6.6%–18.0%) through financial difficulties.

Conclusion: Status anxiety and financial difficulties played small but consistent mediating roles. These individual-level analyses underline status anxiety’s importance and imply that status anxiety requires attention in efforts to reduce health inequalities.
OriginalsprogEngelsk
Artikelnummer1606069
TidsskriftInternational Journal of Public Health
Vol/bind68
Antal sider9
ISSN1661-8556
DOI
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
The HELIUS study is conducted by the Amsterdam University Medical Centers, location AMC, and the Public Health Service of Amsterdam. Both organizations provided core support for HELIUS. The HELIUS study is also funded by the Dutch Heart Foundation (project number 2010T084), the Netherlands Organization for Health Research and Development (ZonMw) (project number 200500003), the European Union (FP-7) (project number 278901), and the European Fund for the Integration of non-EU immigrants (EIF) (project number 2013EIF013). The study reported here was additionally supported by the Netherlands Organization for Health Research and Development (ZonMw) (project number 531003015).

Funding Information:
The HELIUS study is conducted by the Amsterdam University Medical Centers, location AMC, and the Public Health Service of Amsterdam. Both organizations provided core support for HELIUS. The HELIUS study is also funded by the Dutch Heart Foundation (project number 2010T084), the Netherlands Organization for Health Research and Development (ZonMw) (project number 200500003), the European Union (FP-7) (project number 278901), and the European Fund for the Integration of non-EU immigrants (EIF) (project number 2013EIF013). The study reported here was additionally supported by the Netherlands Organization for Health Research and Development (ZonMw) (project number 531003015).

Publisher Copyright:
Copyright © 2023 Crielaard, Motazedi, Galenkamp, van de Werfhorst, Hulvej Rod, Kuipers, Nicolaou and Stronks.

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