Skip to main content
SpringerLink
Log in

Soziale Ungleichheit und Diabetes

Trifft es Arme öfter?

Social inequality and diabetes

Are the poor affected more often?

  • Leitthema
  • Published:
Der Diabetologe Aims and scope

Zusammenfassung

Die Prävalenz der wichtigsten Risikofaktoren für den Typ-2-Diabetes ist in Deutschland in den unteren Statusgruppen besonders hoch, entsprechend steigen auch Inzidenz und Prävalenz des Typ-2-Diabetes mit abnehmendem sozialem Status. Beim Typ-1-Diabetes ist der Zusammenhang mit dem sozioökonomischen Status bisher kaum untersucht, dennoch gibt es auch hier Hinweise auf einen inversen Zusammenhang zwischen dem sozialen Status und der Inzidenz. Der Einfluss des sozialen Status auf die Gesundheit macht auch bei Patienten mit Diabetes nicht Halt, so dass Diabetespatienten mit niedrigem sozialen Status beispielsweise öfter unter Komplikationen leiden. Die Faktoren, die die genannten Zusammenhänge zumindest teilweise erklären können, sind vielfältig: Sie reichen vom Gesundheitsverhalten und der Gesundheitskompetenz der Patienten über den Zugang zum Gesundheitssystem bis zu Merkmalen des Behandlungsprozesses. Auf Grundlage dieser Faktoren werden abschließend einige Empfehlungen für die Gesundheitspolitik und für niedergelassene Ärzte formuliert.

Abstract

In Germany, the most important risk factors for type 2 diabetes have been shown to be more prevalent in lower status groups, and accordingly the incidence and prevalence of type 2 diabetes increase with decreasing socioeconomic status. For type 1 diabetes, the association between disease and social status has been scarcely investigated. Nevertheless, there are indications to suggest an inverse relationship between social status and the incidence of type 1 diabetes as well. Social status also has an impact on the health status of diabetic patients; for example, diabetic patients with a low social status suffer more often from complications. Factors at least partly explaining these relationships range from the health behavior and health literacy of patients to access to the health system and on to characteristics of the treatment process. On the basis of these factors, some recommendations for health politicians and practice-based physicians are specified.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Arnold-Wörner N, Holle R, Rathmann W et al (2008) The importance of specialist treatment, treatment satisfaction and diabetes education for the compliance of subjects with type 2 diabetes – Results from a population-based survey. Exp Clin Endocrinol Diabetes 116:123–128

    Article  PubMed  Google Scholar 

  2. Bachmann MO, Eachus J, Hopper CD et al (2003) Socio-economic inequalities in diabetes complications, control, attitudes and health service use: a cross-sectional study. Diabet Med 20:921–929

    Article  CAS  PubMed  Google Scholar 

  3. Brown AF, Ettner SL, Piette J et al (2004) Socioeconomic position and health among persons with diabetes mellitus: a conceptual framework and review of the literature. Epidemiol Rev 26:63–77

    Article  PubMed  Google Scholar 

  4. Chaturvedi N, Jarrett J, Shipley MJ et al (1998) Socioeconomic gradient in morbidity and mortality in people with diabetes: cohort study findings from the Whitehall study and the WHO multinational study of vascular disease in diabetes. BMJ 316:100–105

    CAS  PubMed  Google Scholar 

  5. Daneman D (2006) Type 1 diabetes. Lancet 367:847–858

    Article  CAS  PubMed  Google Scholar 

  6. Dragano N, Bobak M, Wege N et al (2007) Neighbourhood socioeconomic status and cardiovascular risk factors: a multilevel analysis of nine cities in the Czech Republic and Germany. BMN Public Health 7:255

    Article  Google Scholar 

  7. Du Prel JB, Icks A, Grabert M et al (2007) Socioeconomic conditions and type 1 diabetes in childhood in North Rhine-Westphalia, Germany. Diabetologia 50:720–728

    Article  Google Scholar 

  8. Espelt A, Borrell C, Roskam AJ et al (2008) Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century. Diabetologia 51:1971–1979

    Article  CAS  PubMed  Google Scholar 

  9. Haire-Joshu D, Glasgow RE, Tibbs TL (1999) Smoking and diabetes. Diabetes Care 22:1887–1898

    Article  CAS  PubMed  Google Scholar 

  10. Helmert U, Shea S (1994) Social inequalities and health status in Western Germany. Public Health 108:341–356

    Article  CAS  PubMed  Google Scholar 

  11. Hurrelmann K (2006) Gesundheitssoziologie. Eine Einführung in sozialwissenschaftliche Theorien von Krankheitsprävention und Gesundheitsförderung. Juventa, Weinheim München

  12. Icks A, Moebus S, Feuersenger A et al (2007) Diabetes prevalence and association with social status – widening of a social gradient? German national health surveys 1990–1992 and 1998. Diab Res Clin Prac 78:293–297

    Article  Google Scholar 

  13. Kumari M, Head J, Marmot M (2004) Prospective study of social and other risk factors for incidence of type 2 diabetes in the Whitehall II Study. Arch Intern Med 164:1873–1880

    Article  PubMed  Google Scholar 

  14. Lampert T, Kroll LE, Dunkelberg A (2007) Soziale Ungleichheit der Lebenserwartung in Deutschland. Aus Politik und Zeitgeschichte (APuZ) 42:11–18

    Google Scholar 

  15. Maty SC, Everson-Rose SA, Haan MN et al (2005) Education, income, occupation and the 34-year incidence (1965–99) of type 2 diabetes in the Alameda County Study. Int J Epidemiol 34:1274–1281

    Article  PubMed  Google Scholar 

  16. Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e.V. Präventionsbericht 2008. Leistungen der gesetzlichen Krankenversicherung in der Primärprävention und der betrieblichen Gesundheitsförderung. Berichtsjahr 2007

  17. Mielck A (2005) Soziale Ungleichheit und Gesundheit. Einführung in die aktuelle Diskussion. Huber, Bern

  18. Mielck A, Reisig V, Rathmann W (2005) Health inequalities among persons with type 2 diabetes: the example of intermittent claudication. Gesundheitswesen 67 Sonderheft 1:S137–S143

    Article  Google Scholar 

  19. Mielck A, Reitmeir P, Rathmann W (2006) Knowledge about diabetes and participation in diabetes training courses: the need for improving health care for diabetes patients with low SES. Exp Clin Endocrinol Diabetes 114:240–248

    Article  CAS  PubMed  Google Scholar 

  20. Mielck A (2008) Die Ärzte sind die natürlichen Anwälte der Armen – Der Beitrag von Ärzten zur Verringerung der gesundheitlichen Ungleichheit. Dtsch Med Wochenschr 27:1457–1460

    Article  Google Scholar 

  21. Mühlhauser I, Overmann H, Bender R et al (1998) Social status and the quality of care for adult people with Type 1 (insulin-dependent) diabetes mellitus – a population-based study. Diabetologia 41:1139–1150

    Article  PubMed  Google Scholar 

  22. Mühlhauser I, Overmann H, Bender R et al (2000) Predictors of mortality and end-stage diabetic complications in patients with Type 1 diabetes mellitus on intensified insulin therapy. Diabet Med 17:727–734

    Article  PubMed  Google Scholar 

  23. Rathmann W, Haastert B, Icks A et al (2005) Sex differences in the associations of socioeconomic status with undiagnosed diabetes mellitus and impaired glucose tolerance in the elderly population: the KORA Survey 2000. Eur J Public Health 15:627–633

    Article  CAS  PubMed  Google Scholar 

  24. Reisig V, Reitmeir P, Döring A et al (2007) Social inequalities and outcomes in type 2 diabetes in the German region of Augsburg. A cross-sectional survey. Int J Public Health 52:158–165

    Article  PubMed  Google Scholar 

  25. Robbins JM, Vaccarino V, Zhang H et al (2005) Socioeconomic status and diagnosed diabetes incidence. Diabetes Res Clin Pract 68:230–236

    Article  PubMed  Google Scholar 

  26. Rosenbauer J, Icks A, Schmitter D et al (2002) Incidence of childhood type 1 diabetes mellitus is increasing at all ages in Germany. Diabetologia 45:457–458

    Article  CAS  PubMed  Google Scholar 

  27. Rückert IM, Böcken J, Mielck A (2008) Are German patients burdened by the practice charge for physician visits (‚Praxisgebuehr‘)? A cross sectional analysis of socio-economic and health related factors. BMC Health Serv Res 8:232

    Article  PubMed  Google Scholar 

  28. Schillinger D, Grumbach K, Piette J et al (2002) Association of health literacy with diabetes outcomes. JAMA 288:475–482

    Article  PubMed  Google Scholar 

  29. Toschke AM, Lüdde R, Eisele R et al (2005) The obesity epidemic in young men is not confined to low social classes – a time series of 18-year-old German men at medical examination for military service with different educational attainment. Int J Obesity 29:875–877

    Article  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Deutsches Diabetes Zentrum an der Heinrich-Heine Universität, Auf’m Hennekamp 65, 40225, Düsseldorf, Deutschland

    B. Kowall

  2. Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Helmholtz Zentrum München, Postfach 1129, 85758, Neuherberg, Deutschland

    A. Mielck

Authors
  1. B. Kowall
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Mielck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to B. Kowall or A. Mielck.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kowall, B., Mielck, A. Soziale Ungleichheit und Diabetes. Diabetologe 6, 196–202 (2010). https://doi.org/10.1007/s11428-009-0498-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11428-009-0498-6

Schlüsselwörter

Keywords

Search

Navigation