Impact of Socioeconomic Inequalities on the Incidence of Type 2 Diabetes Mellitus: A Systematic Review
DOI:
https://doi.org/10.19166/med.v15i2.10972Keywords:
Type 2 diabetes, socioeconomic position, education, occupationAbstract
ckground:
Type 2 diabetes mellitus (T2DM) is a rising global burden, and socioeconomic inequalities may shape risk through differential resources, environments, and access to prevention and care. We synthesised evidence on the association between socioeconomic position (SEP) and incident T2DM.
Methods:
We conducted a PRISMA 2020–guided systematic review of PubMed, EMBASE, and Scopus (inception to 18 January 2026). Observational studies of adults without diabetes at baseline that measured SEP (education, income, occupation and/or area deprivation) prior to diagnosis and reported incident T2DM were eligible. Random-effects meta-analyses pooled relative risks (RRs), treating hazard ratios as approximations. Risk of bias was assessed (NOS).
Result:
From 1,580 records, 25 studies met inclusion criteria and 23 contributed to quantitative synthesis. Studies were mainly prospective cohorts or nested case–control designs, largely from high-income countries, with follow-up from 3 to 34 years and participants aged 18–86 years. Lower education was associated with higher T2DM incidence (least vs most educated: RR 1.55, 95% CI 1.37–1.75). Lower occupational position was also associated with increased risk (lowest vs highest: RR 1.60, 95% CI 1.25–2.05). Income was not statistically conclusive (lowest vs highest: RR 1.37, 95% CI 0.94–2.01).
Conclusions:
Socioeconomic disadvantage, particularly lower education and occupational status, is consistently associated with higher risk of incident T2DM. Prevention and screening should incorporate SEP to better target upstream determinants.
References
1. Yang L, Xie D, Liu F, Lin J, Lin X, Chen Y, et al. Global and Regional Burden of Type 2 Diabetes Mellitus Attributable to Low Physical Activity From 1990 to 2021. J Diabetes. 2025;17:e70043.
2. World Health Organization. Diabetes [Internet]. Diabetes. 2024 [cited 2026 Jan 18]. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes
3. Hossain MJ, Al-Mamun M, Islam MR. Diabetes mellitus, the fastest growing global public health concern: Early detection should be focused. Health Sci Rep. 2024;7:e2004.
4. Schäfer H, Lajmi N, Valente P, Pedrioli A, Cigoianu D, Hoehne B, et al. The Value of Clinical Decision Support in Healthcare: A Focus on Screening and Early Detection. Diagnostics. 2025;15:648.
5. Abel ED, Gloyn AL, Evans-Molina C, Joseph JJ, Misra S, Pajvani UB, et al. Diabetes mellitus—Progress and opportunities in the evolving epidemic. Cell. 2024;187:3789–820.
6. Kivimäki M, Virtanen M, Kawachi I, Nyberg ST, Alfredsson L, Batty GD, et al. Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222 120 individuals. Lancet Diabetes Endocrinol. 2015;3:27–34.
7. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;n71.
8. Lo CKL, Mertz D, Loeb M. Newcastle-Ottawa Scale: comparing reviewers’ to authors’ assessments. BMC Med Res Methodol. 2014;14:45.
9. Lidfeldt J, Li TY, Hu FB, Manson JE, Kawachi I. A prospective study of childhood and adult socioeconomic status and incidence of type 2 diabetes in women. Am J Epidemiol. 2007;165:882–9.
10. Cabrera C, Hakeberg M, Ahlqwist M, Wedel H, Björkelund C, Bengtsson C, et al. Can the relation between tooth loss and chronic disease be explained by socio-economic status? A 24-year follow-up from the population study of women in Gothenburg, Sweden. Eur J Epidemiol. 2005;20:229–36.
11. Swai AB, Lutale J, McLarty DG. Diabetes in tropical Africa: a prospective study, 1981-7. I. Characteristics of newly presenting patients in Dar es Salaam, Tanzania, 1981-7. BMJ. 1990;300:1103–6.
12. Maskarinec G, Erber E, Grandinetti A, Verheus M, Oum R, Hopping BN, et al. Diabetes incidence based on linkages with health plans: the multiethnic cohort. Diabetes. 2009;58:1732–8.
13. Medalie JH, Papier C, Herman JB, Goldbourt U, Tamir S, Neufeld HN, et al. Diabetes mellitus among 10,000 adult men. I. Five-year incidence and associated variables. Isr J Med Sci. 1974;10:681–97.
14. Gaillard TR, Schuster DP, Bossetti BM, Green PA, Osei K. Do sociodemographics and economic status predict risks for type II diabetes in African Americans? Diabetes Educ. 1997;23:294–300.
15. Maty SC, Everson-Rose SA, Haan MN, Raghunathan TE, Kaplan GA. Education, income, occupation, and the 34-year incidence (1965-99) of Type 2 diabetes in the Alameda County Study. Int J Epidemiol. 2005;34:1274–81.
16. Costa LMFC da, Mussi ADH, Brianeze MR, Souto FJD. Hepatitis C as a risk factor for diabetes type 2: lack of evidence in a hospital in central-west Brazil. Braz J Infect Dis. 2008;12:24–6.
17. Mehta SH, Brancati FL, Strathdee SA, Pankow JS, Netski D, Coresh J, et al. Hepatitis C virus infection and incident type 2 diabetes. Hepatology. 2003;38:50–6.
18. Wang CS, Wang ST, Yao WJ, Chang TT, Chou P. Hepatitis C virus infection and the development of type 2 diabetes in a community-based longitudinal study. Am J Epidemiol. 2007;166:196–203.
19. Burchfiel CM, Curb JD, Rodriguez BL, Yano K, Hwang LJ, Fong KO, et al. Incidence and predictors of diabetes in Japanese-American men. The Honolulu Heart Program. Ann Epidemiol. 1995;5:33–43.
20. Bourdel-Marchasson I, Dubroca B, Letenneur L, Fourrier A, Richard-Harston S, Decamps A, et al. Incidence and predictors of drug-treated diabetes in elderly French subjects. The PAQUID Epidemiological Survey. Diabet Med. 2000;17:675–81.
21. Hawkins Carranza F, Corbatón-Anchuelo A, Bermejo Pareja F, Martín-Arriscado Arroba C, Vega-Quiroga S, Benito-León J, et al. Incidence of type 2 diabetes in the elderly in Central Spain: Association with socioeconomic status, educational level, and other risk factors. Prim Care Diabetes. 2022;16:279–86.
22. Conrad N, Misra S, Verbakel JY, Verbeke G, Molenberghs G, Taylor PN, et al. Incidence, prevalence, and co-occurrence of autoimmune disorders over time and by age, sex, and socioeconomic status: a population-based cohort study of 22 million individuals in the UK. Lancet. 2023;401:1878–90.
23. Kaye SA, Folsom AR, Sprafka JM, Prineas RJ, Wallace RB. Increased incidence of diabetes mellitus in relation to abdominal adiposity in older women. J Clin Epidemiol. 1991;44:329–34.
24. Kaye SA, Folsom AR, Sprafka JM, Prineas RJ, Wallace RB. Increased incidence of diabetes mellitus in relation to abdominal adiposity in older women. J Clin Epidemiol. 1991;44:329–34.
25. Haffner SM, Hazuda HP, Mitchell BD, Patterson JK, Stern MP. Increased incidence of type II diabetes mellitus in Mexican Americans. Diabetes Care. 1991;14:102–8.
26. Nagaya T, Yoshida H, Takahashi H, Kawai M. Policemen and firefighters have increased risk for type-2 diabetes mellitus probably due to their large body mass index: a follow-up study in Japanese men. Am J Ind Med. 2006;49:30–5.
27. Kumari M, Head J, Marmot M. Prospective study of social and other risk factors for incidence of type 2 diabetes in the Whitehall II study. Arch Intern Med. 2004;164:1873–80.
28. Gao WG, Qiao Q, Pitkäniemi J, Wild S, Magliano D, Shaw J, et al. Risk prediction models for the development of diabetes in Mauritian Indians. Diabet Med. 2009;26:996–1002.
29. Kouvonen AM, Väänänen A, Woods SA, Heponiemi T, Koskinen A, Toppinen-Tanner S. Sense of coherence and diabetes: a prospective occupational cohort study. BMC Public Health. 2008;8:46.
30. Radzeviciene L, Ostrauskas R. Smoking habits and the risk of type 2 diabetes: a case-control study. Diabetes Metab. 2009;35:192–7.
31. Robbins JM, Vaccarino V, Zhang H, Kasl SV. Socioeconomic status and diagnosed diabetes incidence. Diabetes Res Clin Pract. 2005;68:230–6.
32. Ezeamama AE, Viali S, Tuitele J, McGarvey ST. The influence of socioeconomic factors on cardiovascular disease risk factors in the context of economic development in the Samoan archipelago. Soc Sci Med. 2006;63:2533–45.
33. Norberg M, Stenlund H, Lindahl B, Andersson C, Eriksson JW, Weinehall L. Work stress and low emotional support is associated with increased risk of future type 2 diabetes in women. Diabetes Res Clin Pract. 2007;76:368–77.
34. Matchanova A, Sheppard DP, Medina LD, Morgan EE, Woods SP. Health literacy mediates the effects of educational attainment on online pharmacy navigation skills in older adults with HIV disease. Psychol Health. 2023;38:348–68.
35. Seidler A, Schubert M, Freiberg A, Drössler S, Hussenoeder FS, Conrad I, et al. Psychosocial Occupational Exposures and Mental Illness. Dtsch Arztebl Int. 2022;119:709–15.
36. Vasilescu MD, Stănilă L. Inequality of Opportunity in Income and Education: Evidence from Central and Eastern Europe. Economies. 2025;13:275.
37. Brook A, Rendall G, Hearty W, Meier P, Thomson H, Macnamara A, et al. What is the relationship between changes in the size of economies and mortality derived population health measures in high income countries: A causal systematic review. Social Science & Medicine. 2024;357:117190.
38. Sun H, Liang C, Zuo B, Wang M. Diet, oxidative stress, and the mediating role of obesity in postmenopausal women. BMC Womens Health. 2025;25:458.
39. Aizawa T. Socio-economic gradients in hypertension and diabetes management amid the COVID-19 pandemic in India. PLoS One. 2025;20:e0315867.
40. Ahmed T, Kishore J, Onamika M, Goswami S, Momo IR, Sumon H, et al. Comparing Glucometer-Based and Laboratory-Based OGTT for Diabetes Diagnosis: A Narrative Review. Endocrines. 2025;6:48.
41. Grubic N, Johnston A, Grandi SM. Probabilistic Quantitative Bias Analysis for Misclassification and Uncontrolled Confounding: A Methodological Tutorial Using Real-World Data. Canadian Journal of Cardiology. 2025;S0828282X25015776.
42. Holt-Lunstad J. Social connection as a critical factor for mental and physical health: evidence, trends, challenges, and future implications. World Psychiatry. 2024;23:312–32.
43. Hill-Briggs F, Adler NE, Berkowitz SA, Chin MH, Gary-Webb TL, Navas-Acien A, et al. Social Determinants of Health and Diabetes: A Scientific Review. Diabetes Care. 2020;44:258–79.
44. Wijaya JH, Hulou S, Lucke-Wold B, V WBG, Lamprecht CB, Ruchika F, et al. Socioeconomic status as a determinant of survival in glioblastoma: a systematic review and meta-analysis. Neurosurg Rev. 2025;48:500.
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Copyright (c) 2026 Calvin Sasongko, Jessica Adrya, Srigita Varsha, Sony A. Fatchurrahman, Galih Muchlis Hermawan, Veriantara Satya Dhika, Teddy Tjahyanto
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