Elsevier

Health Policy

Volume 99, Issue 2, February 2011, Pages 116-123
Health Policy

Diabetes prevalence and income: Results of the Canadian Community Health Survey

https://doi.org/10.1016/j.healthpol.2010.07.018Get rights and content

Abstract

This paper contributes to a growing body of literature indicating the importance of income as a key socioeconomic status marker in accounting for the increased prevalence of type 2 diabetes (T2DM).

Methods

We analyzed data from the Canadian Community Health Survey cycle 3.1 conducted by Statistics Canada. Descriptive statistics on the prevalence of self-reported diabetes were computed. Multiple logistic regression was used to examine the association between income and prevalence of T2DM.

Results

In 2005 an estimated 1.3 million Canadians (4.9%) reported having diabetes. The prevalence of T2DM in the lowest income group is 4.14 times higher than in the highest income group. Prevalence of diabetes decreases steadily as income goes up. The likelihood of diabetes was significantly higher for low-income groups even after adjusting for socio-demographic status, housing, BMI and physical activity. There is a graded association between income and diabetes with odds ratios almost double for men (OR 1.94, 95% CI 1.57–2.39) and almost triple for women (OR 2.75 95% CI 2.24–3.37) in the lowest income compared to those in highest income.

Conclusion

These findings suggest that strategies for diabetes prevention should combine person-centered approaches generally recommended in the diabetes literature research with public policy approaches that acknowledge the role of socioeconomic position in shaping T2DM prevalence/incidence.

Introduction

Diabetes mellitus (diabetes) is the seventh leading cause of death in Canada that affects over two million Canadians [1]. From the three types of diabetes, type 2 diabetes (T2DM) affects approximately 90% of Canadians diagnosed with diabetes [2] and is the primary focus of this paper. With the aging of the Canadian population, the number of cases of T2DM is projected to increase.

While the mainstream medical literature acknowledges the “multifactorial” nature of diabetes [3], [4], a substantive body of literature subscribes to an individualistic discourse which emphasizes the characteristics of patients (their biology, behaviours, psychological states, or culture) and focuses on changing patients’ attitudes and risk behaviours rather than changing the economic circumstances that may have led to disease-promoting attitudes and behaviours [5]. However, there is an increasing literature that highlights the importance of the social determinants of health in the incidence and management of diabetes [6], [7], [8]. T2DM seems to be common in all populations in industrialized countries affecting disproportionately socially and materially disadvantaged adults [9], [10], [11], [12], [13], [14]. The risk of diabetes is also greater for people who are obese [15], physically inactive [16], or have hypertension [17], all these conditions being more common among people with low socioeconomic position. Evidence of increasing income inequality among Canadians and increasing numbers of low-income families during the past decade [18] directs special attention to the potential effects of low income upon the health and wellbeing of those living with diabetes [19].

This paper examines the relationship between income and T2DM using a large Canadian data set that allows for greater ability to detect differences across income levels among men and women. In addition, it assesses the role of a number of behavioural antecedents, important socio-demographics, and additional markers of economic security in mediating the association between income and diabetes, factors which are common conceptualizations related to population health [20], [21], [22], [23], [24].

This study contributes to the literature that emphasizes the special role of income within the web of social determinants of health as it influences the quality of early life, levels of stress, availability and quality of food and social exclusion [25], [26].

Section snippets

Data sources and sample

We analyzed data from the Canadian Community Health Survey (CCHS) cycle 3.1. This is a cross-sectional survey conducted by Statistics Canada that collects information related to health status, health care utilization and health determinants for the Canadian population living in private occupied dwellings in 122 health regions covering all provinces and territories. Data for Cycle 3.1 were collected between January and December 2005 and covers approximately 98% of the Canadian population aged 12

Results

The distribution of key variables considered in the study for men and women is summarized in Table 1. In 2005, an estimated 1.3 million Canadians reported T2DM which accounted for 4.9% of the population with higher prevalence in men than women (5.3% vs. 4.4%). T2DM remains a disease of the elderly, with 13.5% of seniors being diabetic compared to 5.8% of 45–59 years old and 1.3% of people aged 30–44. Across age groups, there was no difference in diabetes prevalence between men and women for the

Discussion

T2DM is a chronic condition potentially influenced by a web of factors. Some of these factors are physiological and genetic as well as health behaviours related, but social and economic statuses are also important. We used a large population-based Canadian data to explore the predictive effects of income on the prevalence of T2DM among women and men with consideration of various covariates mediating these effects.

Our study indicated a trend of increased prevalence of T2DM towards the lower end

Conclusion

Findings from this study underscore the importance of income among a web of factors in determining the risk of T2DM, regardless of other factors that may confound or mediate these associations. Canada is experiencing a period of both growing income inequality and a parallel increase in diabetes mortality, especially in low-income neighbourhoods. Therefore, strategies for diabetes prevention should address the socioeconomic inequalities in addition to person-centred approaches. Our findings

Acknowledgements

We thank the Research Data Centre at University of Toronto for facilitating the access to the data.

Funding: This study was supported by the Social Sciences and Humanities Research Council (SSHRC) grant entitled: The Societal Determinants of the Incidence and Management of Diabetes.

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