The Prevalence of Diabetes Among Overweight and Obese Individuals is Higher in Poorer than in Richer Neighbourhoods



      Diabetes is increasing in prevalence worldwide. This study investigated whether the elevated prevalence of diabetes in lower-income neighbourhoods could be explained by higher rates of overweight and obesity.


      A total of 7434 patients who attended respiratory clinics in 2 Ontario cities were linked to administrative databases to ascertain diagnoses of diabetes, chronic obstructive pulmonary disease and asthma. Body mass index (BMI) was obtained from clinic databases and median neighbourhood income from the Canadian census. Prevalence ratios were estimated by log-linear multiple binary regression.


      BMI and neighbourhood income were independently associated with the prevalence of diabetes. At any level of BMI, subjects living in richer neighbourhoods were less likely to have been diagnosed with diabetes than subjects in poorer neighbourhoods.


      In addition to body weight, neighbourhood income-related factors are associated with the risk of diabetes. These may include diet, physical activity and pollution exposures. Additional etiologic research is required to explain the income-related differential. From a resource perspective, the health care system will need to invest resources in low-income neighbourhoods to provide counselling and treatment for those individuals at risk for diabetes or for those already diagnosed.



      La prévalence mondiale du diabète augmente. Cette étude a évalué si la hausse de la prévalence du diabète dans les quartiers à faible revenu pouvait être attribuée aux taux élevés d'embonpoint et d'obésité qu'on y retrouve.


      Un total de 7434 patients de cliniques de pneumologie de deux villes ontariennes ont été reliés à des bases de données administratives pour confirmer les diagnostics de diabète, de bronchopneumopathie chronique obstructive et d'asthme. On a obtenu l'indice de masse corporelle (IMC) dans les bases de données des cliniques et le revenu médian du quartier dans le recensement du Canada. Les rapports de prévalence ont été évalués par régression multiple et binaire log-linéaire.


      L'IMC et le revenu médian du quartier ont été indépendamment associés à la prévalence du diabète. Quel que soit l'IMC, les sujets qui habitaient un quartier riche étaient moins susceptibles d'être atteints de diabète que ceux qui habitaient un quartier pauvre.


      En plus du poids corporel, des facteurs liés au revenu médian du quartier sont associés au risque de diabète, dont l'alimentation, l'activité physique et l'exposition à la pollution. La recherche étiologique devra se poursuivre pour expliquer la différence liée au revenu. Le système de santé devra investir des ressources dans les quartiers à faible revenu pour que les personnes exposées au diabète et celles qui en sont déjà atteintes puissent être conseillées et traitées.



      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Canadian Journal of Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hossain P.
        • Kawar B.
        • El Nahas M.
        Obesity and diabetes in the developing world — a growing challenge.
        N Engl J Med. 2007; 356: 213-215
        • Lipscombe L.L.
        • Hux J.E.
        Trends in diabetes prevalence, incidence, and mortality in Ontario, Canada 1995–2005: a population-based study.
        Lancet. 2007; 369: 750-756
      1. Diabetes in Canada. 2nd ed. Center for Chronic Disease Prevention and Control, Health Canada, Ottawa, ON2002
        • Rabi D.M.
        • Edwards A.L.
        • Southern D.A.
        • et al.
        Association of socio-economic status with diabetes prevalence and utilization of diabetes care services.
        BMC Health Serv Res. 2006; 6: 124
        • Robbins J.M.
        • Vaccarino V.
        • Zhang H.
        • et al.
        Socioeconomic status and type 2 diabetes in African American and non-Hispanic white women and men: evidence from the Third National Health and Nutrition Examination Survey.
        Am J Public Health. 2001; 91: 76-83
        • Connolly V.
        • Unwin N.
        • Sherriff P.
        • et al.
        Diabetes prevalence and socioeconomic status: a population based study showing increased prevalence of type 2 diabetes mellitus in deprived areas.
        J Epidemiol Community Health. 2000; 54: 173-177
        • Evans J.M.
        • Newton R.W.
        • Ruta D.A.
        • et al.
        Socio-economic status, obesity and prevalence of Type 1 and Type 2 diabetes mellitus.
        Diabet Med. 2000; 17: 478-480
        • Squires B.P.
        Cardiovascular disease and socioeconomic status.
        CMAJ. 2000; 162: S3
        • Finkelstein M.M.
        • Jerrett M.
        • DeLuca P.
        • et al.
        Relation between income, air pollution and mortality: a cohort study.
        CMAJ. 2003; 169: 397-402
        • Finkelstein M.M.
        • Jerrett M.
        • Sears M.R.
        Traffic air pollution and mortality rate advancement periods.
        Am J Epidemiol. 2004; 160: 173-177
        • Finkelstein M.M.
        • Jerrett M.
        • Sears M.R.
        Environmental inequality and circulatory disease mortality gradients.
        J Epidemiol Community Health. 2005; 59: 481-487
        • Rana J.S.
        • Mittleman M.A.
        • Sheikh J.
        • et al.
        Chronic obstructive pulmonary disease, asthma, and risk of type 2 diabetes in women.
        Diabetes Care. 2004; 27: 2478-2484
        • Barros A.J.
        • Hirakata V.N.
        Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio.
        BMC Med Res Methodol. 2003; 3: 21
        • Glazier R.
        • Booth G.
        Neighbourhood Environments and Resources for Healthy Living — A Focus on Diabetes in Toronto.
        Institute for Clinical Evaluative Sciences, Toronto, ON2007
        • Diez Roux A.V.
        Residential environments and cardiovascular risk.
        J Urban Health. 2003; 80: 569-589
        • Morland K.
        • Diez Roux A.V.
        • Wing S.
        Supermarkets, other food stores, and obesity: the atherosclerosis risk in communities study.
        Am J Prev Med. 2006; 30: 333-339
        • Diez-Roux A.V.
        • Nieto F.J.
        • Caulfield L.
        • et al.
        Neighbourhood differences in diet: the Atherosclerosis Risk in Communities (ARIC) Study.
        J Epidemiol Community Health. 1999; 53: 55-63
        • Finkelstein M.M.
        Ecologic proxies for household income: how well do they work for the analysis of health and health care utilization?.
        Can J Public Health. 2004; 95: 90-94
        • Van Dam R.M.
        • Rimm E.B.
        • Willett W.C.
        • et al.
        Dietary patterns and risk for type 2 diabetes mellitus in U.S. men.
        Ann Intern Med. 2002; 136: 201-209
        • Hu F.B.
        • Manson J.E.
        • Stampfer M.J.
        • et al.
        Diet, lifestyle, and the risk of type 2 diabetes mellitus in women.
        N Engl J Med. 2001; 345: 790-797
        • Garriguet D.
        Overview of Canadians' Eating Habits.
        Statistics Canada, Ottawa, ON2004 (82-620-M1E No. 2)
        • Hu F.B.
        • Leitzmann M.F.
        • Stampfer M.J.
        • et al.
        Physical activity and television watching in relation to risk for type 2 diabetes mellitus in men.
        Arch Intern Med. 2001; 161: 1542-1548
        • Millar W.J.
        • Young T.K.
        Tracking diabetes: prevalence, incidence and risk factors.
        Health Rep. 2003; 14: 35-47
        • Craig C.L.
        • Russell S.J.
        • Cameron C.
        • et al.
        Twenty-year trends in physical activity among Canadian adults.
        Can J Public Health. 2004; 95: 59-63
        • Finkelstein M.M.
        • Jerrett M.
        A study of the relationships between Parkinson's disease and markers of traffic-derived and environmental manganese air pollution in two Canadian cities.
        Environ Res. 2007; 104: 420-432
        • Wellen K.E.
        • Hotamisligil G.S.
        Inflammation, stress, and diabetes.
        J Clin Invest. 2005; 115: 1111-1119
        • Shoelson S.E.
        • Lee J.
        • Goldfine A.B.
        Inflammation and insulin resistance.
        J Clin Invest. 2006; 116: 1793-1801
        • Finkelstein M.M.
        Diesel particulate exposure and diabetes mortality among workers in the Ontario construction trades.
        Occup Environ Med. 2008; 65: 215
        • Salvi S.
        • Blomberg A.
        • Rudell B.
        • et al.
        Acute inflammatory responses in the airways and peripheral blood after short-term exposure to diesel exhaust in healthy human volunteers.
        Am J Respir Crit Care Med. 1999; 159: 702-709
        • Takizawa H.
        Diesel exhaust particles and their effect on induced cytokine expression in human bronchial epithelial cells.
        Curr Opin Allergy Clin Immunol. 2004; 4: 355-359