For many years, people were told that obesity, diet, lack of physical activity, and genetics were the most pressing risk factors for Type 2 diabetes. However, studies from around the globe have shown that an even bigger determining factor for developing diabetes is socioeconomic status. More specifically, research has shown that living in poverty drastically increases the risk of developing Type 2 diabetes.
Additional risks for developing Type 2 diabetes are often present in poor populations, including level of education, a dangerous home environment, obesity, stress, and unhealthy behaviours such as drinking alcohol and smoking. Studying the effects of poverty on diabetes can be difficult because it is a challenge to control for such risks.
However, a Canadian study has shown that, even when controlling for factors like education, physical activity levels, and body mass index, lower-income populations showed an increased risk of developing the disease.
Canadian researchers from York University looked at data from the Canadian Community Health Survey (CCHS) and the National Population Health Survey (NPHS) for their study. Analyzing data from the CCHS, researchers found that men who earned less than $15,000 per year, the lowest income bracket, were at double the risk of developing diabetes than men who earned over $80,000 per year, the highest income bracket. The increased risk remained the same even when taking education, physical activity, and body mass index into account.
The same set of data showed an even larger risk of developing diabetes for women. Women in the lowest income bracket were at triple the risk of developing diabetes when compared to women in the highest income bracket. When controlling for education, physical activity, and body mass index, the risk was still more than double between the two income groups.
Studying data from the NPHS, researchers observed that the risk of developing diabetes increased by 24 percent if the person lived in poverty in the two years before their diagnosis. That figure remained unchanged when taking weight and physical activity into account. Data also showed that the risk increased by 26 percent if the person lived in poverty at any time, and that subjects who spent more time living in poverty over the 12-year study showed a 41 percent greater risk of developing diabetes. When physical activity and obesity were taken into consideration, the risk only lessened slightly, to 36 percent.
A study from Taiwan showed similar results. Researchers used the Taiwan National Health Insurance (NHI) database in 2000 to identify a representative group of diabetes-free subjects who they could follow until 2005. Researchers used adjusted hazards ratios to discover excess risk factors of diabetes in the poor group.
The study found that poor subjects were more likely to develop Type 2 diabetes during the follow-up period than subjects from other income groups. Like the Canadian study, the Taiwanese study also showed a difference between men and women. Men from the poor group were 40 percent more at risk than men from middle-income groups, while women from the poor group were 60 percent more at risk.
Both the Canadian and Taiwanese studies found that poorer populations were also more likely to suffer from diabetes complications, even though subjects from both studies received universal health coverage.
In the Taiwanese study, researchers found that approximately 50 percent of subjects from the poor group did not receive professional medical care for diabetes until they required hospitalization for severe complications or symptoms. Additionally, once diagnosed, about 45 percent of subjects from the poor group did not visit a diabetes clinic within one year of their diagnosis. The same individuals were approximately 50 percent less likely to attend recommended checkups associated with their diagnosis.
Researchers from the Canadian study interviewed diabetes patients from low-income neighbourhoods and found that 72 percent of respondents reported that they did not have the financial resources to manage their diabetes properly. This included not being able to afford the kind of food necessary for management and lacking the resources for medical supplies such as blood sugar test strips.
Researchers from both studies cite limited access to healthy food choices, increased stress and lack of community and social support as factors within poorer populations that may contribute to an increased risk of diabetes. Stress is of particular concern, as it increases the level of cortisol in the body, interfering with the body’s use of insulin.
Understanding and acknowledging the impact of poverty on diabetes is essential to providing better care for patients. Instead of focusing primarily on physical activity and eating habits, professionals specializing in diabetes care must understand the socio-economic conditions and systemic stressors that inhibit access to proper diabetes prevention and management tools.