Socioeconomic status and diabetes among Mexican adults

Diabetes is a significant health problem in Mexico and one of the leading causes of death. Studies in other countries have suggested that socioeconomic status (SES) contributes to the development of type 2 diabetes. However, only few studies in Mexico have dealt with SES differentials in diabetes. The aim of this thesis is to examine the association between SES and type 2 diabetes among Mexican adults aged 20-69. In contrast with previous studies, we use individual, household and municipality measures of SES simultaneously when investigating: prevalence of total, diagnosed and undiagnosed diabetes in the year 2000; and incidence of diagnosed diabetes during the period 2002-2005. Furthermore, we explore the effects of diabetes on employment status, and changes in waist circumference (WC) among adults with diabetes.Data were used from the 2000 National Health Survey (NHS-2000) and the Mexican Family Life Surveys 2002 and 2005 (MxFLS-2002 and MxFLS-2005). Diabetes was defined using self-reports (in both surveys) and outcomes from capillary blood tests (only in the NHS). SES was measured through educational attainment, household income, household wealth and municipality deprivation. The index of household wealth was calculated and evaluated using the National Survey of Household Income and Expenditure (ENIGH-2000). The Human Development Index (HDI) and the Deprivation Index (DI) at the municipality level are official statistics obtained from the 2000 Mexican Census of population. Two level logistic regression models were estimated, and the analyses were stratified mainly by sex, urban/rural stratum and municipality deprivation.Our findings confirm an association between socioeconomic status and diabetes. However, this relationship varies by SES measure, sex, urbanisation and deprivation. A consistent result was that diabetes was more common among the less educated, in the least deprived municipalities, and in urbanised localities. Variations in diabetes between municipalities were better explained by genetic, biological and lifestyle factors, than by SES. Diabetes was associated with working status, but not with employment status or changes in WC. Increases in urbanisation and further socioeconomic development, in combination with increased life expectancy, will lead to a higher prevalence of diabetes particularly among the most vulnerable groups. In addition to the promotion of healthy behaviours in the overall Mexican population, health sustainability should be prioritized in those communities at early stages of the nutritional and epidemiological transition