Diabetes and socioeconomic status

Socioeconomic status affects the prevalence of diabetes, adherence to recommended screenings, and the development of complications.

Analysis of data from the 2003 Ten-Year Health Survey showed that the prevalence of diabetes was twice as high among people with low educational attainment than among those with higher levels of education, with more pronounced differences among women than among men (Fosse S., 2011; Dalichampt M., 2008). Furthermore, the risk of developing diabetes was approximately twice as high among women of North African origin as among French women, at equivalent socioeconomic and obesity levels.

Analysis of Sniiram data has since confirmed this trend by highlighting a higher prevalence of treated diabetes in the most socio-economically disadvantaged municipalities. In 2012, the prevalence of treated diabetes thus increased significantly according to the territorial index of social disadvantage of the municipality of residence, with a prevalence ratio between the most disadvantaged quintile and the least disadvantaged quintile that was higher among women than among men (Q5/Q1: 1.7 vs. 1.3).

The results of the 2007 Entred study showed that the type 2 diabetic population was, on average, financially struggling, since, in response to the question "Financially, in your household, would you say that...?" ", more than half (53%) of patients reported experiencing financial difficulties ("just getting by," "barely making ends meet," or "unable to make ends meet without going into debt"). Monthly household income (including wages, benefits, and assistance) was less than 1,200 euros for one-third (34%) of individuals, and lower than that of the general population, regardless of age, for those under 75 (source of comparison: INSEE’s 2006 Tax and Social Income Survey). People from lower socioeconomic backgrounds were more likely to have discovered their diabetes through complications rather than through screening. They were more likely to be obese, smoked more, and had poorer glycemic control. They also had a higher prevalence of foot and coronary complications, at equivalent levels of vascular risk. The type 2 diabetic population also includes a high proportion of people born abroad: 17% of men and 22% of women who responded to the 2007 Entred survey were born outside France, with 8% of men and 11% of women born in a Maghreb country. At equivalent socioeconomic levels, people with diabetes of Maghreb origin were less likely to receive the recommended three annual HbA1c tests than those of French origin, and they had poorer glycemic control. They also had more ophthalmological complications.

Data from Sniiram revealed that the incidence of complications was higher among the most socioeconomically disadvantaged people with diabetes. Thus, in 2013, hospitalization rates for lower limb amputation and foot ulcers were 1.5 and 1.4 times higher, respectively, among people with diabetes under the age of 60 who were beneficiaries of the complementary universal health coverage than among non-beneficiaries. They were 1.3 times higher among people living in the most disadvantaged municipalities compared to those living in the most advantaged municipalities. Hospitalization rates for myocardial infarction and stroke were 1.3 and 1.6 times higher, respectively, among people with diabetes under the age of 60 who were beneficiaries of the supplementary universal health coverage than among non-beneficiaries. These disparities were smaller according to a territorial index of social disadvantage.

The prevalence of certain chronic conditions is high among people living in extreme poverty. A study by the Samu Social Observatory estimated the prevalence of diabetes among people housed in emergency shelters and described the characteristics of those already diagnosed. Diabetes screening was systematically offered in 9 Parisian emergency shelters from October to December 2006. Nurses collected sociodemographic data and performed anthropometric measurements, capillary tests, and fasting blood draws. A clinical examination and a medical questionnaire were administered by a physician to known diabetic individuals. Among the 488 participants, 35 reported having diabetes and 2 were newly diagnosed. The prevalence of treated diabetes, adjusted for age and sex, was estimated at 6.1% (95% CI [2.4–9.8]) versus 4.9% [4.8–5.1] among social security beneficiaries over 20 years of age. One-quarter of people with diabetes had at least one macrovascular complication, 32% had retinopathy, and 21% had received ophthalmic laser treatment; 17% had undergone an amputation, 6% had lower limb arteritis, and 35% had a high podiatric risk. This study highlighted the severity of diabetes among people in extreme poverty and advocated for adapting their care, particularly podiatric care. This survey led to the development of recommendations regarding diabetes care for people in extreme poverty.

The incidence of ALD-diabetes was analyzed by major occupational category (general scheme, merchants, artisans, farmers, agricultural workers, and independent professionals) based on data from the three main health insurance schemes: the general scheme, the self-employed scheme, and the agricultural social mutuality.

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