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Increased risk of diabetes and obesity in socioeconomically deprived regions

Living in a socioeconomically deprived region is a risk factor for being affected by diabetes mellitus and obesity. This holds true regardless of the individual social status of the inhabitants. This is the conclusion reached by scientists from the Institute of Health Economics and Health Care Management (IGM) at the Helmholtz Zentrum München (HMGU) and the Department of Epidemiology and Health Monitoring at the Robert Koch Institute (RKI) in Berlin. “Regional factors, such as the population’s average income, unemployment or quality of the living environment can affect the health of all inhabitants, regardless of the educational level of the individual people”, explains the lead author Werner Maier.

Under the leadership of Werner Maier in a team headed by Dr. Andreas Mielck and Professor Dr. Rolf Holle at the HMGU, the group of authors evaluated data from more than 33,000 people aged 30 years or more who participated in the RKI’s German telephone health interview surveys “German Health Update(GEDA)” in 2009 and 2010.

Residents of socioeconomically deprived regions suffer disproportionately from diabetes and overweight. This geographical influence is referred to as “regional deprivation”. It was determined based on the “German Index of Multiple Deprivation” (GIMD) which is formed from regionally available information on income, employment, education, municipal or district revenue, social capital, environment and security in a defined area. In addition to the GIMD, the data analysis also took into consideration individual risk factors such as age, sex, body mass index, smoking status, physical activity, education and living with a partner.

In the most deprived regions, the frequency of type 2 diabetes was 8.6 percent among those interviewed and that of obesity was 16.9 percent, compared to 5.8 and 13.7 percent, respectively, among those interviewed in regions that are only slightly deprived. These results were reviewed to determine relevant differences in all individual factors, with the final result showing that people in the areas with the greatest deprivation still had around a 20 percent greater probability to suffer from type 2 diabetes than men and women in the least deprived regions. In the case of obesity, there was even an almost 30 percent higher probability associated with greater deprivation. For women, high regional deprivation was a particularly influential independent factor for the occurrence of diabetes and obesity. In men, it was possible to show a statistically significant and independent correlation for obesity, but not for diabetes.

“Our results point out the significance of regional factors in association with common health problems such as diabetes mellitus and obesity in Germany”, explains Dr. Andreas Mielck from the HMGU. “Previous investigations in this area were frequently distorted by individual socioeconomic status, or only used data from a particular region or from outside Germany.” Werner Maier adds, “Area-based risk factors such as material and social deprivation are an important starting point in order to develop effective region-specific preventive measures.” Dr. Christa Scheidt-Nave from the RKI reports, ” It is thanks to large, German-wide representative studies such as GEDA that we have current data on the epidemiology of chronic diseases such as diabetes available to us. For comprehensive prevention strategies, we must identify both regional and individual risk factors and also examine their interaction”.

According to the results of Germany-wide health monitoring, some six million people over the age of 18 years are currently affected by diabetes mellitus in Germany, with more than twice as many adults suffering from obesity.


The epidemiological analyses were carried out as a part of the two institutes’ cooperation project on diabetes mellitus and social inequality in the Competence Network for Diabetes Mellitus (‘Kompetenznetz Diabetes mellitus’). The two institutes were supported within this research association by the Bundesministerium für Bildung und Forschung (German Federal Ministry of Education and Research). GEDA data are routinely collected within the framework of Germany-wide health monitoring at the RKI with funding from the Bundesministerium für Gesundheit (Federal Ministry of Health).

Original publication:

Werner Maier, Christa Scheidt-Nave, Rolf Holle, Lars E. Kroll, Thomas Lampert, Yong Du, Christin Heidemann, Andreas Mielck (2014), Area level deprivation is an independent determinant of prevalent type 2 diabetes and obesity at the national level in Germany. Results from the national telephone health interview surveys ‘German Health Update’ GEDA 2009 and 2010, PLOS ONE, doi: pone.0089661

Helmholtz Zentrum München – German Research Center for Environmental Health