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

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

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 physical health outcomes. Methods: 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 (aged 18–70 years) from the Amsterdam-based HELIUS study. 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. Conclusion: Status anxiety and financial difficulties played small but consistent mediating roles. These individual-level analyses underline status anxiety’s importance and imply that status anxiety requires attention in efforts to reduce health inequalities.

Original languageEnglish
Article number1606069
JournalInternational Journal of Public Health
Number of pages9
Publication statusPublished - 2023

Bibliographical note

Publisher Copyright:
Copyright © 2023 Crielaard, Motazedi, Galenkamp, van de Werfhorst, Hulvej Rod, Kuipers, Nicolaou and Stronks.

    Research areas

  • feelings of inferiority, mediation, socioeconomic status, status anxiety, type 2 diabetes

ID: 371044088