Thirteen-year trends in the prevalence of diabetes according to socioeconomic condition and cardiovascular risk factors in a Swiss population.

To estimate the prevalence of and trends in diabetes according to sociodemographic indicators and cardiovascular risk factors in a Swiss population. Annual cross-sectional study of adults residing in the state of Geneva. We included 9886 participants (51% women; mean age (SD) of 48.9 (13.4) years). Diagnosed diabetes was self-reported; undiagnosed diabetes was defined as having fasting plasma glucose level of ≥7 mmol/L and no previous diagnosis; total diabetes as the sum of diagnosed and undiagnosed diabetes. To assess trends, we grouped survey years into three time periods: 2005-2010, 2011-2014, and 2015-2017. To assess inequalities, we constructed the relative index of inequality (RII) and the slope index of inequality (SII) for education, income, and health insurance subsidy (state program based on socioeconomic disadvantage). In total, 683 diabetes cases were identified. In 2015-2017, total diabetes prevalence was 11.8% (8.6%-14.9%) among lowest income participants, and 4.7% (3.4%-5.9%) among highest income participants (p<0.01). Similar findings were observed for education. Among participants with full health insurance subsidy, diabetes prevalence was 19.4% (12.1%-26.8%), and 6.1% (5.3%-7.0%) among those without (p<0.01). High diabetes prevalence was observed among participants who were men, older, overweight or obese, hypertensive, and hypercholesterolemic. Among participants with diabetes, 74.0% (63.5%-84.4%) in the lowest income group were diagnosed, compared with 90.2% (81.9%-98.4%) in the highest income group (p=0.04). Over the 13-year period, widening relative and absolute inequalities in total diabetes prevalence were observed for education and income. The education-RII (95% CI) increased from 1.51 (95% CI 1.01 to 2.32) in 2005-2010 to 2.54 (95% CI 1.58 to 4.07) in 2015-2017 (p=0.01), and the education-SII (95% CI) from 0.04 (95% CI 0.01 to 0.08) to 0.08 (95% CI 0.04 to 0.10; p<0.01). The income-RII increased from 2.35 (95% CI 1.44 to 3.84) to 3.91 (95% CI 2.24 to 6.85; p<0.01), and the income-SII from 0.08 (95% CI 0.04 to 0.12) to 0.011 (95% CI 0.07 to 0.14; p=0.01). Inequalities by health insurance subsidy were large (RII 3.56 (95% CI 1.90 to 6.66) and SII 0.10 (95% CI 0.05 to 0.15)) but stable across the study period. Among adults living in Geneva, Switzerland, substantial differences were observed in diabetes prevalence across socioeconomic and cardiovascular risk groups over a 13-year period, and relative and absolute socioeconomic inequalities appeared to have increased.

de Mestral C ，Stringhini S ，Guessous I ，Jornayvaz FR ... -  《BMJ Open Diabetes Research &amp; Care》

Twelve-year (2008-2019) trends in socioeconomic inequalities in cardiovascular risk factors in a Swiss representative survey of the general population.

We assessed trends in socioeconomic inequalities in cardiovascular risk factors prevalence among Swiss adults from 2008 to 2019. Using data from the Bus Santé study, an annual survey of adults living in Geneva, Switzerland, we calculated the prevalence per period and by demographic and socioeconomic indicators, assessing inequality trends using the relative index of inequality (RII) and the slope index of inequality (SII). Among 10,739 participants, most CVD risk factors decreased over time, while diabetes, obesity, and smoking prevalence remained steady. In 2017-2019, prevalence of most CVD risk factors was higher in socioeconomically disadvantaged groups. Relative and absolute inequalities decreased over time, but mostly remained, for hypertension [in 2017-2019, education-RII (95 % CI) = 1.27 (1.12-1.46), income-RII = 1.27 (1.10-1.47)], hypercholesterolemia [education-RII = 1.15 (1.00-1.32)], and sedentarity [education-RII = 1.95 (1.52-2.51), income-RII = 1.69 (1.28-2.23)], and appeared to have reversed for hazardous alcohol use [income-RII = 0.75 (0.60-0.93)]. Substantial and persistent relative and absolute inequalities in diabetes prevalence were observed [education-RII = 2.39 (1.75-3.27), income-RII = 3.18 (2.25-4.48), and subsidy-RII = 2.77 (1.89-4.05)]. Inequalities were also marked across all socioeconomic indicators for obesity prevalence [education-RII = 3.32 (2.63-4.19), income-RII = 2.37 (1.85-3.04), subsidy-RII = 1.98 (1.48-2.66)] and for smoking [education-RII = 2.42 (2.06-2.84), income-RII = 2.37 (1.99-2.84), subsidy-RII = 1.91 (1.56-2.35)]. Over 12 years in Geneva, Switzerland, socioeconomic inequalities in hypertension, hypercholesterolemia, hazardous alcohol use, and sedentarity decreased but persist, while substantial inequalities in diabetes, obesity, and smoking remained unchanged.

de Mestral C ，Piumatti G ，Nehme M ，Guessous I ，Stringhini S ... -  《-》

Trends and Regional Variation in Prevalence of Cardiovascular Risk Factors and Association With Socioeconomic Status in Canada, 2005-2016.

Dai H ，Younis A ，Kong JD ，Bragazzi NL ，Wu J ... -  《JAMA Network Open》

Inequalities in the prevalence of diabetes mellitus and its risk factors in Sri Lanka: a lower middle income country.

De Silva AP ，De Silva SHP ，Haniffa R ，Liyanage IK ，Jayasinghe S ，Katulanda P ，Wijeratne CN ，Wijeratne S ，Rajapaksa LC ... -  《International Journal for Equity in Health》

Educational and wealth inequalities in tobacco use among men and women in 54 low-income and middle-income countries.

Socioeconomic differentials of tobacco smoking in high-income countries are well described. However, studies to support health policies and place monitoring systems to tackle socioeconomic inequalities in smoking and smokeless tobacco use common in low-and-middle-income countries (LMICs) are seldom reported. We aimed to describe, sex-wise, educational and wealth-related inequalities in tobacco use in LMICs. We analysed Demographic and Health Survey data on tobacco use collected from large nationally representative samples of men and women in 54 LMICs. We estimated the weighted prevalence of any current tobacco use (including smokeless tobacco) in each country for 4 educational groups and 4 wealth groups. We calculated absolute and relative measures of inequality, that is, the slope index of inequality (SII) and relative index of inequality (RII), which take into account the distribution of prevalence across all education and wealth groups and account for population size. We also calculated the aggregate SII and RII for low-income (LIC), lower-middle-income (lMIC) and upper-middle-income (uMIC) countries as per World Bank classification. Male tobacco use was highest in Bangladesh (70.3%) and lowest in Sao Tome (7.4%), whereas female tobacco use was highest in Madagascar (21%) and lowest in Tajikistan (0.22%). Among men, educational inequalities varied widely between countries, but aggregate RII and SII showed an inverse trend by country wealth groups. RII was 3.61 (95% CI 2.83 to 4.61) in LICs, 1.99 (95% CI 1.66 to 2.38) in lMIC and 1.82 (95% CI 1.24 to 2.67) in uMIC. Wealth inequalities among men varied less between countries, but RII and SII showed an inverse pattern where RII was 2.43 (95% CI 2.05 to 2.88) in LICs, 1.84 (95% CI 1.54 to 2.21) in lMICs and 1.67 (95% CI 1.15 to 2.42) in uMICs. For educational inequalities among women, the RII varied much more than SII varied between the countries, and the aggregate RII was 14.49 (95% CI 8.87 to 23.68) in LICs, 3.05 (95% CI 1.44 to 6.47) in lMIC and 1.58 (95% CI 0.33 to 7.56) in uMIC. Wealth inequalities among women showed a pattern similar to that of men: the RII was 5.88 (95% CI 3.91 to 8.85) in LICs, 1.76 (95% CI 0.80 to 3.85) in lMIC and 0.39 (95% CI 0.09 to 1.64) in uMIC. In contrast to men, among women, the SII was pro-rich (higher smoking among the more advantaged) in 13 of the 52 countries (7 of 23 lMIC and 5 of 7 uMIC). Our results confirm that socioeconomic inequalities tobacco use exist in LMIC, varied widely between the countries and were much wider in the lowest income countries. These findings are important for better understanding and tackling of socioeconomic inequalities in health in LMIC.

Sreeramareddy CT ，Harper S ，Ernstsen L 《-》