Depression, neighborhood deprivation and risk of type 2 diabetes.

Neighborhood characteristics have been associated with both depression and diabetes, but to date little attention has been paid to whether the association between depression and diabetes varies across different types of neighborhoods. This prospective study examined the relationship between depression, neighborhood deprivation, and risk of type 2 diabetes among 336,340 adults from a national-representative sample of primary care centers in Sweden (2001-2007). Multi-level logistic regression models were used to assess associations between depression and risk of type 2 diabetes across affluent and deprived neighborhoods. After accounting for demographic, individual-level socioeconomic, and health characteristics, depression was significantly associated with risk of diabetes (odds ratio (OR): 1.10, 95% confidence interval (CI): 1.06-1.14), as was neighborhood deprivation (OR for high vs. low deprivation: 1.66, 95% CI: 1.22-1.34). The interaction term between depression and neighborhood deprivation was non-significant, indicating that the relationship between depression and diabetes risk is similar across levels of neighborhood socioeconomic deprivation.

Neighborhood deprivation and inequities in coronary heart disease among patients with diabetes mellitus: a multilevel study of 334,000 patients.

We used multilevel models to investigate whether the odds of coronary heart disease (CHD) is higher in patients with diabetes mellitus (DM) living in deprived neighborhoods versus those living in wealthy neighborhoods. The Swedish nationwide prescription register was used to identify 334,000 patients aged 30 years and older with DM. The OR of CHD was significantly higher among patients with DM living in deprived neighborhoods than among patients with DM living in wealthy neighborhoods. These findings are useful for clinicians working in deprived neighborhoods. Future research could focus on how to reduce inequities in CHD among patients with DM.

Country of birth, socioeconomic factors, and risk factor control in patients with type 2 diabetes: a Swedish study from 25 primary health-care centres.

BACKGROUND: Few large-scale studies have examined the association between sociodemographic factors and the probability of reaching the recommended levels of haemoglobin A1c (HbA(1c)) and blood lipids in patients with type 2 diabetes. The aim was to investigate whether sociodemographic characteristics of patients with type 2 diabetes affected the odds that they would reach recommended levels of blood lipids and HbA(1c). METHODS: This study included 2912 men and 2136 women, in the age group of 35-74, with diagnosed type 2 diabetes from 25 primary health-care centres in Stockholm, Sweden. National population registers were linked to clinical data from electronic records and logistic regression was used to estimate odds ratios. RESULTS: Less than half of the men and women with diabetes reached the recommended levels of HbA(1c). Even fewer reached the recommended levels for total cholesterol and low-density lipoprotein cholesterol. The gender differences favoured women, for HbA(1c) and men, for blood lipids. Individuals with the lowest income levels were less likely to reach the recommended level of HbA(1c). Country of birth showed that immigrants from Middle Eastern countries and other countries had lower odds of reaching the recommended levels of HbA(1c). CONCLUSION: This study confirmed that risk factor control among patients with type 2 diabetes treated in primary health care is inadequate and that sociodemographic factors were associated with metabolic control. Future studies could include new strategies for the control of modifiable risk factors in patients with type 2 diabetes.