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Socioeconomic status is not associated with type 2 diabetes incidence in an elderly population in Germany: KORA S4/F4 Cohort Study
  1. Bernd Kowall1,
  2. Wolfgang Rathmann1,
  3. Klaus Strassburger1,
  4. Christine Meisinger2,
  5. Rolf Holle3,
  6. Andreas Mielck3
  1. 1Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
  2. 2Helmholtz Zentrum München, National Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
  3. 3Helmholtz Zentrum München, National Research Center for Environmental Health, Institute of Health Economics, Neuherberg, Germany
  1. Correspondence to Dr W Rathmann, German Diabetes Center, Institute of Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany; rathmann{at}


Background An association between socioeconomic status (SES) and the incidence of type 2 diabetes mellitus (T2DM) has been found for younger and middle-aged individuals, but studies of this relationship in elderly populations are rare.

Methods In a population-based cohort in southern Germany (KORA S4/F4: 1223 subjects aged 55–74 years at baseline, 887 subjects (73%) in the follow-up 7 years later) the identification of incident T2DM was based on oral glucose tolerance tests or on validated physician diagnoses. Regression models were fitted to predict incident T2DM and (pre)diabetes, respectively, with SES as the main independent variable. (Pre)diabetes here means incident T2DM or incident pre-diabetes.

Results With five different SES measures (global Helmert index, income, educational level, occupational status, subjective social status), the diabetes risk of low SES groups was not significantly different from the risk of higher SES groups (ie, cumulative incidence 10% (low income), 9% (medium income), 13% (high income)). In subjects with normoglycaemia at baseline, (pre)diabetes incidence was more pronounced in lower SES groups, but almost all these associations were not significant. With measures of subjective SES stronger associations were found than with measures of objective SES.

Conclusion There was no statistically significant association between objective SES and diabetes incidence in this elderly population. This might be due to a larger socioeconomic homogeneity of elderly populations and to a strong driving force for diabetes, which outweighed the influence of SES, and which was indicated by an adverse baseline metabolic profile in participants developing diabetes in the follow-up.

  • Elderly population
  • pre-diabetes
  • social epidemiology
  • socioeconomic status
  • type 2 diabetes

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  • Funding The Diabetes Cohort Study was funded by a German Research Foundation project grant to WR (DFG; RA 459/2-1). The German Diabetes Center is funded by the German Federal Ministry of Health and the Ministry of School, Science and Research of the State of North-Rhine-Westfalia. The KORA research platform and the KORA Augsburg studies are financed by the Helmholtz Zentrum München, German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education, Science, Research and Technology and by the State of Bavaria.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the ethics committee of the Bavarian Medical Association.

  • Provenance and peer review Not commissioned; externally peer reviewed.