The importance of material deprivation in type 2 diabetes incidence: longitudinal analyses in the Maastricht study

Aim: Type 2 diabetes mellitus (T2DM) is a common chronic disease that disproportionately affects groups with a low socioeconomic position (SEP). In addition to traditional SEP measures, material deprivation allows for further differentiation between people at the bottom of the socioeconomic hierarchy. This study therefore aimed to examine longitudinal associations between material deprivation and incident T2DM, independent of traditional SEP measures and childhood income inadequacy. Methods: Longitudinal data from 4,553 participants without T2DM at baseline in The Maastricht Study were used (52.4% female, mean age 57.9 (SD 8.6) years). Material deprivation was based on a 20-item questionnaire including lack of basic goods due to financial reasons, debts, economic strain and perceived financial problems. The highest completed educational level, household income equivalent, occupational position and childhood income inadequacy were measured at baseline by means of questionnaires. Incident T2DM was self-reported yearly (up to 12 years of follow-up). Associations were studied with Cox regression analyses. Results: Reported incident T2DM was 3.2% over 8.2 (median) years of follow-up. The risk for incident T2DM was significantly higher among people with material deprivation and for people with lower income, independent of education, occupation and childhood income inadequacy, with a hazard ratio (HR) of 1.38 (95%CI 0.90–2.10) and 1.71 (95%CI 1.08–2.70) for intermediate and high material deprivation, respectively. Conclusion: Material deprivation is a risk factor for incident T2DM, even after accounting for traditional SEP measures such as education, occupation and income. More attention is needed in research and practice for people facing material deprivation. Interventions aimed at reducing health inequalities should also target multiple SEP components and pathways.