National and subnational analysis of diabetes and health inequalities in European Union countries

BACKGROUND: Diabetes mellitus (DM) has been a major public health concern with increased epidemiologic and economic burden in the European Union (EU) member states. We aimed to estimate national and subnational DM prevalence in individuals aged 50 years or over in 13 EU member states between 2010 and 2019. METHODS: The present study extracted microdata from waves 4 - 2010/2011, 5 - 2013, 6 - 2015, and 8 - 2019 of the Survey of Health, Ageing and Retirement in Europe (SHARE) database. The analysis was carried out at national and subnational levels from 13 EU member states. Socioeconomic risk factors such as urbanization, income, and educational level were involved in the analysis. Gini coefficient (GC) and concentration Index (CI) were used to evaluate health inequalities. RESULTS: Prevalence of DM in EU between waves 4 and 8 ranged from 12% to 13.9%, respectively. GC for DM prevalence in EU was 0.140±0.028 (p = 0.00) in wave 4 and 0.141±0.024 (p = 0.00) in wave 8. The highest prevalence was 21.4% in Czechia (wave 8) and the lowest was 6.7% in Switzerland (wave 4). The EU member state with highest GC was Denmark with 0.336±0.085 (p = 0.00) in wave 4 and the lowest was found in Slovenia with 0.001±0.001 (p = 0.04) in wave 5. Urbanization showed the highest CIs, ranging from -0.062±0.030 (p = 0.04) in Italy (wave 8) to 0.079±0.024 (p = 0.00) in France (wave 5). Income ranged from -0.275±0.033 (p = 0.00) in Denmark (wave 5) to -0.007±0.035 (p = 0.85) in Slovenia (wave 4) and educational level from -0.249±0.042 (p = 0.00) in Denmark (wave 4) to -0.028±0.036 (p = 0.43) in Switzerland (wave 5). CONCLUSIONS: In the EU, there are inequalities in the increasing prevalence of DM at national and sub-national levels, with higher rates among those living in non-urban areas, with low educational levels and low income. To tackle such level of health inequalities, the EU and its member states should create prevention programs and policies that prioritize vulnerable groups. KEY MESSAGES: • Our research highlights inequalities in DM prevalence between and within member states of EU. • The study underlines the need for tailored actions addressing specific regions and vulnerable population.