ArticleDiabetologia2020
Education and incident type 2 diabetes: quantifying the impact of differential exposure and susceptibility to being overweight or obese.
Article in Diabetologia, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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17 citing papers in PubMed.
- Educational attainment and diabetes risk: triangulation evidence from UK Biobank prospective cohort, NHANES 2011-2018, and cross-trait genomics analyses.Frontiers in endocrinology · 2026Article
- Evaluating the Feasibility and Preliminary Effectiveness of a Tailored Diabetes Education Program for Rural Residents.Journal of Appalachian health · 2026Article
- Behavioural and metabolic mediators of socioeconomic inequalities in type 2 diabetes: comparing counterfactual and traditional mediation analysis.European journal of public health · 2025Article
- Prevalence of self-reported symptoms of diabetic autonomic dysfunction in the North Denmark Region: a population-based survey.Acta diabetologica · 2025Article
- The effect of diabetes in the multifaceted relationship between education and cognitive function.BMC public health · 2024Article
- The effect of socioeconomic status, depression, and diabetes symptoms severity on diabetes patient's life satisfaction in India.Scientific reports · 2024Article
- Impact of the association between education and obesity on diabetes-free life expectancy.European journal of public health · 2023Article
- Triglycerides, Obesity and Education Status Are Associated with the Risk of Developing Type 2 Diabetes in Young Adults, Cohort Study.Journal of personalized medicine · 2023Article
- Article
- Demographic variables, anthropometric indices, sleep quality, Metabolic Equivalent Task (MET), and developing diabetes in the southwest of Iran.Frontiers in public health · 2023Article
- Gender Differences in Unhealthy Lifestyle Behaviors among Adults with Diabetes in the United States between 1999 and 2018.International journal of environmental research and public health · 2022Article
- Obesity mediates the opposite association of education and diabetes in Chinese men and women: Results from the REACTION study.Journal of diabetes · 2022Article
- Prevalence, awareness, treatment, and control of type 2 diabetes mellitus among the adult residents of tehran: Tehran Cohort Study.BMC endocrine disorders · 2022Article
- COVID-19 pandemic impact on people with diabetes: results from a large representative sample of Italian older adults.Primary care diabetes · 2022Article
- Mediators of the association between educational attainment and type 2 diabetes mellitus: a two-step multivariable Mendelian randomisation study.Diabetologia · 2022Article
- Lifestyle choices mediate the association between educational attainment and BMI in older adults in China: A cross-sectional study.Frontiers in public health · 2022Article
- Working life expectancies among individuals with type 1 and type 2 diabetes over a 30-year period.Scandinavian journal of work, environment & health · 2021Article
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Abstract
aims/hypothesisEducational inequality in type 2 diabetes incidence is evident in many high-income countries. Previous studies have shown that differential exposure to being overweight/obese across educational groups may partly explain this inequality. Whether differential susceptibility to being overweight/obese across educational groups contributes to this inequality has been investigated less frequently, even though it is a plausible mechanism. The two mechanisms may even be highly intertwined. In this longitudinal cohort study, we investigated the simultaneous contribution of differential exposure and differential susceptibility to being overweight/obese to educational inequality in type 2 diabetes incidence.
methodsThe study population comprised 53,159 Danish men and women aged 50-64 years at baseline who were followed for a mean of 14.7 years. We estimated rate differences of type 2 diabetes by education level per 100,000 person-years. Using counterfactual mediation analysis, these rate differences were decomposed into proportions attributable to differential exposure, differential susceptibility and all other pathways, respectively. We compared this approach with conventional approaches to mediation and interaction analysis.
resultsCompared with a high level of education, a low education level was associated with 454 (95% CI 398, 510) additional cases of type 2 diabetes, and a medium education level with 316 (CI 268, 363) additional cases. Differential exposure to being overweight/obese accounted for 37% (CI 31%, 45%) of the additional cases among those with a low education level and 29% (CI 24%, 36%) of the additional cases among those with a medium education level. Differential susceptibility accounted for 9% (CI 4%, 14%) and 6% (CI 3%, 10%) of the additional cases among those with a low and medium education level, respectively. Compared with the counterfactual approach, the conventional approaches suggested stronger effects of both mechanisms. CONCLUSIONS/
interpretationDifferential exposure and susceptibility to being overweight/obese are both important mechanisms in the association between education and type 2 diabetes incidence.
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