社会经济地位与2型糖尿病：社会凝聚力的中介作用——马斯特里赫特研究

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine Pub Date : 2025-04-15 DOI:10.1016/j.socscimed.2025.118046

Jeroen D. Albers , Annemarie Koster , Bengisu Sezer , Rachelle Meisters , Jeffrey A. Chan , Anke Wesselius , Miranda T. Schram , Bastiaan E. de Galan , Jeroen Lakerveld , Hans Bosma

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引用次数: 0

摘要

社会经济地位与2型糖尿病之间的关系已经确立；社会经济地位较低的人患此病的几率要高得多。本研究探讨了感知和计量区域社会凝聚力在社会经济地位与2型糖尿病发病之间的中介作用。在马斯特里赫特研究（The Maastricht Study）中，我们分析了6604名参与者（年龄= 58.6岁，55%为女性）的数据，中位随访时间为8.1年（IQR为5.1-10.1）。我们研究了感知到的或区域层面的社会凝聚力（在500平方米，五个字符的邮政编码区域和邻里区域）是否介导了社会经济地位（以教育程度、职业地位或收入为代表）与2型糖尿病发病率之间的关联。我们采用了基于线性回归和Cox比例风险模型的因果中介方法。社会经济地位较低的个人更有可能感受到较低的社会凝聚力，并生活在社会凝聚力下降的地区。较低的地区社会凝聚力与患2型糖尿病的风险增加有关。社会凝聚力的中介作用在城市地区更为明显。在城市地区，教育对2型糖尿病发病率的总影响（对比第83百分位和第17百分位）为2.03 (95% CI: 1.62-2.58)，区域层面的社会凝聚力介导了24.4%（11.1%-40.3%）的影响。在城市较少的地区，社会凝聚力介导了12.6%（5.2%-23.0%）的风险比（1.89(1.50-2.40)）。在职业状况和收入以及其他聚集水平上也观察到类似的结果。社会经济地位与较低的社会凝聚力有关，这与患2型糖尿病的风险增加有关。加强弱势地区的社会凝聚力可能有助于减少与糖尿病相关的健康差距，特别是在城市环境中。需要进一步的研究来更好地理解这些关系背后的机制。

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Socioeconomic position and type 2 diabetes: Examining the mediating role of social cohesion—The Maastricht Study

The relationship between socioeconomic position and type 2 diabetes is well-established; individuals of lower socioeconomic position experience substantially higher rates of the disease. This study investigated the mediating role of perceived and ecometric area-level social cohesion in the association between socioeconomic position and incident type 2 diabetes.

In a prospective population-based cohort, The Maastricht Study, we analyzed data from 6,604 participants (

\bar{age}

= 58.6 years, 55% female) with a median follow-up of 8.1 (IQR 5.1–10.1) years. We examined whether perceived or area-level social cohesion (in 500 m squares, five-character postal code areas, and neighborhood areas) mediated the association between socioeconomic position (represented by educational attainment, occupational status, or income) and incident type 2 diabetes. We employed a causal mediation approach based on linear regression and Cox proportional hazards models.

Individuals with lower socioeconomic position were more likely to perceive lower social cohesion and to live in areas with diminished social cohesion. Lower area-level social cohesion was associated with an increased risk of developing type 2 diabetes. The mediating effect of social cohesion was more pronounced in urban areas. In urban areas, the total effect of education (contrasting the 83rd and 17th percentiles) on type 2 diabetes incidence was a hazard ratio (HR) of 2.03 (95% CI: 1.62–2.58), with area-level social cohesion mediating 24.4% (11.1%–40.3%) of this effect. In less urban areas, social cohesion mediated 12.6% (5.2%–23.0%) of a HR of 1.89 (1.50–2.40). Similar findings were observed with occupational status and income, and across other aggregation levels.

Socioeconomic position is linked to lower social cohesion, which is associated with an increased risk of type 2 diabetes. Enhancing social cohesion in disadvantaged areas may help reduce diabetes-related health disparities, particularly in urban settings. Further research is needed to better understand the mechanisms underlying these relationships.

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来源期刊

Social Science & Medicine PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

9.10

自引率

5.60%

发文量

762

审稿时长

38 days

期刊介绍： Social Science & Medicine provides an international and interdisciplinary forum for the dissemination of social science research on health. We publish original research articles (both empirical and theoretical), reviews, position papers and commentaries on health issues, to inform current research, policy and practice in all areas of common interest to social scientists, health practitioners, and policy makers. The journal publishes material relevant to any aspect of health from a wide range of social science disciplines (anthropology, economics, epidemiology, geography, policy, psychology, and sociology), and material relevant to the social sciences from any of the professions concerned with physical and mental health, health care, clinical practice, and health policy and organization. We encourage material which is of general interest to an international readership.