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

Loes Crielaard; Ehsan Motazedi; Henrike Galenkamp; Herman G van de Werfhorst; Naja Hulvej Rod; Mirte A G Kuipers; Mary Nicolaou; Karien Stronks

doi:10.3389/ijph.2023.1606069

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

Int J Public Health. 2023 Oct 2:68:1606069. doi: 10.3389/ijph.2023.1606069. eCollection 2023.

Authors

Loes Crielaard¹, Ehsan Motazedi¹, Henrike Galenkamp¹, Herman G van de Werfhorst², Naja Hulvej Rod³, Mirte A G Kuipers¹, Mary Nicolaou¹, Karien Stronks¹

Affiliations

¹ Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
² Department of Political and Social Sciences, European University Institute, Florence, Italy.
³ Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

Abstract

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.

Keywords: feelings of inferiority; mediation; socioeconomic status; status anxiety; type 2 diabetes.

MeSH terms

Anxiety / epidemiology
Cross-Sectional Studies
Diabetes Mellitus, Type 2* / epidemiology
Health Status Disparities
Humans
Social Class
Socioeconomic Factors

Grants and funding

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).