La Selección de libros, la censura y otros problemas vigentes

The aim of this section is to examine if there is a relationship between self-reported diabetes and SES and in case that there is, what the nature of this relationship is.

Secondly, if a relationship exists, we inquire if the relationship between self-reported diabetes and SES varies by urban/rural areas, sex, and level of municipality deprivation.

Logistic regression models were estimated where the dependent variable classified as adults having diabetes only to those with “self-reported diabetes” (2,396 adults), otherwise they were classified as not having diabetes.

Unadjusted and adjusted odds ratios for self-reported diabetes by socioeconomic status are given in Table 8.15 in the appendix. The odds ratios of most of the variables had a similar direction and significance as those of the total diabetes model. In contrast with the adjusted odds ratios of total diabetes, a significant negative graded association was observed between diabetes and the Deprivation Index.

Table 5.13 and Table 5.14 report the odds ratios of the multiple regression models for self-reported diabetes. The models were estimated as in the previous section. The final model for self-reported diabetes at the national level is displayed in the first column of Table 5.13. Sex, spoken language and kinship were not significant in the final model.

The odds ratios of the rest of the risk factors, potential mediators and occupation had a similar direction and magnitude as those of the diabetes model. In this subsection self-reported diabetes is just mentioned as diabetes.

Adults in the first category of household wealth were less likely to have diabetes compared to adults in the highest category of household wealth. The odds of having diabetes increased with decreasing levels of education. Adults living in a remote area were less likely to have diabetes than adults living in a non remote area. HDI had a higher significance than the Deprivation Index. There were no differences in the odds between adults living in municipalities with a high HDI when compared to adults living in municipalities with a medium_high HDI; thus, these categories were collapsed.

Adults living in municipalities with a low to medium-low Human Development Index were less likely to have diabetes than adults living in municipalities with a

medium_high-high HDI. There were no significant interactions, random slopes or cross-level interactions. The standard deviation for the municipality effect was 0.18.

Education had a similar association with diabetes in the stratified models as in the national level (Table 5.13), except for the most deprived municipalities (using both deprivation measures). In the rural stratum, men and municipalities with medium HDI, medium deprivation, and high deprivation, there was a positive association between diabetes and household wealth. Among women and municipalities with high HDI and low deprivation, adults in the lowest category of household wealth were less likely to have diabetes than adults in the highest categories (4 and 5). There was no association between diabetes and household wealth in urban areas and municipalities with low HDI.

There were no differences in the probability of having diabetes between people living in remote areas and people living in non remote areas among women and municipalities with high HDI, medium HDI, and low to medium Deprivation Index. In men, there was no association between diabetes and HDI. A random-effects model could not be fitted for low HDI and medium/high Deprivation Index.

Home makers were more likely to have diabetes than employees only in the urban area, women and municipalities with a high/low Deprivation Index. There were no

differences in the probability of having diabetes by health care access among men and among the most disadvantaged municipalities. There was no difference in the

probability of having diabetes in adults by marital status in municipalities with low HDI and with a medium to high Deprivation Index.

Table 5.13 Odds ratios for self-reported diabetes at the national level, by stratum and HDI

Stratum HDI

Total Urban Rural High Medium Low

N 39,752 21,593 18,159 18,626 18,919 2,183

Age group

20-29 0.12*** 0.12*** 0.11*** 0.12*** 0.11*** 0.12**

30-39 0.33*** 0.35*** 0.30*** 0.34*** 0.32*** 0.21**

40-49 1.00 1.00 1.00 1.00 1.00 1.00

50-59 2.33*** 2.44*** 2.19*** 2.53*** 2.15*** 2.01

60-69 3.24*** 3.50*** 2.95*** 3.64*** 2.89*** 2.89*

Family history of diabetes

None 1.00 1.00 1.00 1.00 1.00 1.00

Only father or mother 2.43*** 2.21*** 2.83*** 2.27*** 2.58*** 4.58***

Both parents 5.81*** 5.69*** 5.97*** 6.09*** 5.26*** 9.29*

Missing 1.22 1.29 1.2 1.26 1.08 2.28

Waist circumference

Normal 1.00 1.00 1.00 1.00 1.00 1.00

Abdominal obesity 1.44*** 1.39*** 1.48*** 1.43*** 1.44*** 1.32

Missing 1.35* 1.21 1.55* 1.08 1.71** 1.19

Household wealth

1 (lowest SES) 0.56*** 0.56 0.54*** 0.38* 0.52*** 0.97 2 and 3 0.91 0.98 0.85* 1.07 0.79** 1.07

4 and 5 (highest SES) 1.00 1.00 1.00 1.00 1.00 1.00

Missing 0.51* 0.41 0.62 0.26* 0.85 -^a

Education

High school/above 1.00 1.00 1.00 1.00 1.00 1.00

Secondary/below 1.70*** 1.63*** 1.77*** 1.64*** 1.75*** 0.73

Missing 1.83*** 1.97*** 1.73** 2.02*** 1.83*** 0.43

Z-test significance for individual coefficients: *p<0.05, **p<0.01, ***p<0.001; - not included in the models.

Table 5.13 Odds ratios for self-reported diabetes at the national level, by stratum

Divorced/Separated/Widowed 1.09 1.06 1.13 1.04 1.15 1.25

Live in a remote area

Z-test significance for individual coefficients: *p<0.05, **p<0.01, ***p<0.001; -not included in the models. National model has 321 municipalities, min=17 adults, max=873 adults, average=123.8. Model for urban stratum has 151 municipalities, min=18 adults, max=710, average=143. Model for rural stratum has 204 municipalities, min=17 adults, max=274, average=89. Model for high HDI: 99 municipalities, min=18 adults, max=873, average=188.1. Model for medium HDI: 196 municipalities, min=17 adults, max=274, average=96.5.

Table 5.14 Odds ratios for self-reported diabetes by sex and Deprivation Index

Sex Deprivation Index

Men Women Low Medium High

N 12,147 27,605 27,551 6,105 6,021

Age group

20-29 0.12*** 0.12*** 0.12*** 0.11*** 0.10***

30-39 0.32*** 0.34*** 0.33*** 0.29*** 0.33***

40-49 1.00 1.00 1.00 1.00 1.00

50-59 2.00*** 2.47*** 2.30*** 2.40*** 2.43***

60-69 2.95*** 3.38*** 3.37*** 2.80*** 3.06***

Family history of diabetes

None 1.00 1.00 1.00 1.00 1.00

Only father or mother 2.09*** 2.60*** 2.31*** 2.88*** 2.83***

Both parents 5.02*** 6.39*** 5.76*** 4.78*** 7.35***

Missing 0.88 1.39* 1.17 1.35 1.32

Waist circumference

Normal 1.00 1.00 1.00 1.00 1.00

Abdominal obesity 1.14 1.66*** 1.43*** 1.31 1.55*

Missing 1.49 1.40* 1.24 1.26 2.21*

Household wealth

1 (lowest SES) 0.51** 0.58*** 0.52* 0.45** 0.52**

2 and 3 0.71*** 1.00 1.01 0.71** 0.69*

4 and 5 (highest SES) 1.00 1.00 1.00 1.00 1.00

Missing 0.47 0.56 0.67 - ^-

Education

High school/above 1.00 1.00 1.00 1.00 1.00

Secondary/below 1.53*** 1.81*** 1.65*** 2.06** 1.85

Missing 1.17 2.17*** 1.74*** 2.43** 2.04

Z-test significance for individual coefficients: *p<0.05, **p<0.01, ***p<0.001; -not included in the models.

Table 5.14 Odds ratios for self-reported diabetes by sex and Deprivation Index

Divorced/Separated/Widowed 1.03 1.1 1.07 1.12 1.27

Live in a remote area

Z-test significance for individual coefficients: *p<0.05, **p<0.01, ***p<0.001; -not included in the models. Model for men has 321 municipalities, min=4 adults, max=255, average=37.8. Model for women has 321 municipalities, min=10 adults, max=618, average=86. Model for low deprivation has 187 municipalities, min=17 adults, max=873, average=147.4.

Wide confidence intervals were detected for some categories in the models for higher deprivation. This was mainly due to small cases of diabetes, especially with the HDI measure. For instance, there were very few cases of adults with diabetes among high levels of education. A cross-tabulation and chi-square test showed no association between education and total/ self-reported diabetes among adults living in

municipalities with the lowest HDI. For the highest deprivation strata, models were repeated after excluding categories with wide CIs. The results were similar.