AUTHOR=Crielaard Loes , Motazedi Ehsan , Galenkamp Henrike , van de Werfhorst Herman G. , Hulvej Rod Naja , Kuipers Mirte A. G. , Nicolaou Mary , Stronks Karien 

TITLE=Socioeconomic Inequalities in Type 2 Diabetes: Mediation Through Status Anxiety?

JOURNAL=International Journal of Public Health

VOLUME=Volume 68 - 2023

YEAR=2023

URL=https://www.ssph-journal.org/journals/international-journal-of-public-health/articles/10.3389/ijph.2023.1606069

DOI=10.3389/ijph.2023.1606069

ISSN=1661-8564

ABSTRACT=Objectives While status anxiety has received attention as a potential mechanism generating health inequalities, empirical evidence is still limited. Studies have been ecological and have largely focused on mental and not yet physical health outcomes.We conducted individual-level analyses to assess status anxiety (feelings of inferiority resulting from social comparisons) and resources (financial difficulties) as mediators of the relationship between socioeconomic status (SES) (education/occupation/employment status) and type 2 diabetes (T2D). We used cross-sectional data of 21,150 participants from the Amsterdam-based HELIUS study (aged 18-70 years). We estimated associations using logistic regression models and estimated mediated proportions using natural effect modelling.Results Odds of status anxiety were higher among participants with a low SES (e.g. OR=2.66 (95%CI:2.06-3.45) for elementary versus academic occupation). Odds of T2D were 1.49 (95%CI:1.12-1.97) times higher among participants experiencing status anxiety. Proportion of the SES-T2D relationship mediated was 3.2% (95%CI:1.5-7.0%) through status anxiety and 10.9% (95%CI:6.6-18.0%) through financial difficulties.Conclusions Status anxiety and financial difficulties played small but consistent mediating roles. These individual-level analyses underline status anxiety's importance and imply status anxiety requires attention in efforts to reduce health inequalities.