Do poor psychosocial resources mediate health inequalities in type 2 diabetes mellitus? Findings from the Maastricht study

Author:

Sezer Bengisu1ORCID,Albers Jeroen1,Meisters Rachelle1ORCID,Schram Miranda T234,Köhler Sebastian35,Stehouwer Coen D A2,Koster Annemarie1ORCID,Bosma Hans1

Affiliation:

1. Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University , Maastricht, The Netherlands

2. Department of Internal Medicine, Maastricht University Medical Center+, CARIM School for Cardiovascular Diseases, Maastricht University , Maastricht, The Netherlands

3. MHeNS School for Mental Health and Neuroscience, Maastricht University , Maastricht, The Netherlands

4. Heart and Vascular Center, Maastricht University Medical Center (MUMC+) , Maastricht, The Netherlands

5. Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Alzheimer Centrum Limburg, Maastricht University Medical Center+ , Maastricht, The Netherlands

Abstract

Abstract Low socioeconomic position (SEP) has been identified as a risk factor for type 2 diabetes mellitus (T2DM), and psychosocial resources might be on the pathway in this association. We examined two poor psychosocial resources, low control beliefs and inferiority beliefs, that might link low SEP with T2DM. 8292 participants aged 40–75 living in Southern Netherlands participated in The Maastricht Study starting from September 2010 to October 2020 and were followed up to 10 years with annual questionnaires. SEP (education, income, occupation), low control beliefs, inferiority beliefs, and (pre)diabetes by oral glucose tolerance test were measured at baseline. Incident T2DM was self-reported per annum. We analysed the mediating roles of poor psychosocial resources by using counterfactual mediation analysis. People with low SEP had more often prevalent and incident T2DM (e.g. low education: HR = 2.13, 95%CI: 1.53–2.97). Low control beliefs and high inferiority beliefs were more common among people with low SEP. Moreover, low control beliefs and high inferiority beliefs were risk factors for T2DM (e.g. low control beliefs: HR = 1.50, 95%CI: 1.08–2.09). The relationship between SEP and T2DM was partially mediated by control beliefs (8.0–13.6%) and inferiority beliefs (2.2–4.5%). We conclude that poor psychosocial resources are important in socioeconomic inequalities in diabetes. Researchers and practitioners should consider the psychosocial profile of people with lower SEP, as such a profile might interfere with the development, treatment, and prevention of T2DM. Further research should explore how poor psychosocial resources interact with chronic stress in relation to socioeconomic health inequalities.

Funder

Dutch Research Council

Stichting De Weijerhorst

Pearl String Initiative Diabetes

Cardiovascular Center

School for Mental Health and Neuroscience

Cardiovascular Research Institute Maastricht

School for Public Health and Primary Care

School for Nutrition, Toxicology and Metabolism

Stichting Annadal

Health Foundation Limburg

Publisher

Oxford University Press (OUP)

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