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Study: The role of socio-economic status in the incidence of diabetes

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1994/1995 to 2008/2009

Low levels of household income and education are associated with the onset of type 2 diabetes in Canadian women, independent of other factors such as the well-established relationship with excess weight.

Even allowing for the effects of overweight, obesity and ethno-cultural origin, lower-income women were significantly more likely to develop type 2 diabetes than were their counterparts in high-income households.

By contrast, among men, any relationship between household income and the onset of diabetes disappeared when other factors were taken into account. Instead, the development of diabetes among men was related to being overweight or obese, and to the number of secondary behavioural factors they reported, such as heavy drinking, smoking and physical inactivity.

These findings are derived from the results of the latest release of data from the National Population Health Survey (NPHS), a longitudinal survey that has tracked the health status of a cohort of more than 17,000 Canadians since 1994/1995.

The study of the onset of diabetes is based on 12,333 NPHS respondents who were aged 18 or older in 1994/1995. Among those who had been free of diabetes in 1994/1995, 7.2% of men and 6.3% of women had either developed or died from the disease by 2008/2009.

The study analysed the relationship between the incidence of type 2 diabetes and household income and individual educational attainment. It also examined demographic and behavioural factors that may contribute to this relationship.

For women, even when other factors were considered, a modest association between type 2 diabetes and lower education attainment persisted among those who had only secondary education compared with postsecondary.

For men, the association between type 2 diabetes and lower education attainment disappeared entirely when weight and behavioural factors were taken into account.

In type 2 diabetes, the pancreas produces insulin, but the body develops resistance to its effects, resulting in a relative insulin deficiency. Type 2, which typically occurs in adulthood, accounts for up to 95% of cases. In type 1 diabetes, the pancreas cannot produce insulin, so it must be replaced. Type 1 usually develops in childhood or adolescence.

Definitions, data sources and methods: survey number 3225.

The article, " 14-year diabetes incidence: The role of socio-economic status," which is part of today's Health Reports (82-003-X, free) online release, is now available from the Key resource module of our website under Publications. For more information about this article, contact Heather Gilmour (613-951-2114;, Health Analysis Division.

For more information about the National Population Health Survey, contact Andrew MacKenzie (613-951-2544; or Gina Thompson (613-951-1504;, Health Statistics Division.

Longitudinal data from the eighth cycle of the household component of the National Population Health Survey (NPHS), covering the 1994/1995 to 2008/2009 period is available through the Research Data Centres. For more information, visit The Research Data Centres Program page of our website.

Data tables from the National Population Health Survey on the body mass index, self-rated health, smoking and physical activity are also available.

Related information can also be found in the publication Healthy Today, Healthy Tomorrow? Findings from the National Population Health Survey: "14-year Diabetes Incidence: The Role of Socioeconomic Status” (82-618-M2010008, free).

Today's online release of Health Reports also includes the article "Hospitalization risk in a type 2 diabetes cohort." This article used administrative data and information from the Canadian Community Health Survey to examine the roles of health system and care path factors in the hospitalization of people with type 2 diabetes. For more information, contact Edward Ng (613-951-5308;, Health Analysis Division.

The online edition of Health Reports, Vol. 21, no. 3 (82-003-X, free), is now available from the Key resource module of our website under Publications.

For more information about Health Reports, contact Janice Felman (613-951-6446;, Health Analysis Division.