Aims/hypothesis

High prevalence of coexisting morbidity in people with type 2 diabetes highlights the need to include interactions with education and comorbidity in the assessments of societal consequences of type 2 diabetes. The purpose of this study was to estimate the joint effects of education, type 2 diabetes and six frequent comorbidities.

Methods

Nationwide administrative register data on type 2 diabetes diagnosis, hospital admissions, education and disability pension were grouped at the individual level by means of a unique personal identification number. Included were all people (N = 2,281,599) in the age span of 40–59 years living in Denmark in the period 2005 to 2017, covering a total of 17,754,788 person-years. We used both Cox proportional hazards and Aalen additive hazards models to estimate relative and absolute joint effects of type 2 diabetes, educational attainment and six common comorbidities (CVD, cancer and cerebrovascular, respiratory, musculoskeletal and psychiatric diseases). We decomposed the joint effects of educational level, type 2 diabetes and comorbidities into main effects and the interaction effect, measured as extra cases of disability pension.

Results

Lower level of educational attainment, type 2 diabetes and comorbidities independently contributed to additional granted disability pensions. The joint number of cases of disability pension exceeded the sum of the three exposures, which is explained by a synergistic effect of lower educational level, type 2 diabetes and comorbidity.

Conclusions/interpretation

In this population study, the joint effects of type 2 diabetes, lower education and comorbidity were associated with larger than additive rates of disability pension. An integrated approach that takes into account socioeconomic barriers to type 2 diabetes rehabilitation may slow down disease progression and increase the working ability of socially disadvantaged people.

Graphical abstract

中文翻译：

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教育程度、2型糖尿病和合并症对残疾养老金的联合影响：一项纵向、全国性、基于登记的研究结果

目标/假设

2 型糖尿病患者并存疾病的高患病率凸显了在评估 2 型糖尿病的社会后果时需要纳入与教育和合并症的相互作用。本研究的目的是评估教育、2 型糖尿病和六种常见合并症的联合影响。

方法

关于 2 型糖尿病诊断、住院、教育和残疾养老金的全国行政登记数据通过唯一的个人识别号在个人层面进行分组。包括所有人（N = 2,281,599）在 2005 年至 2017 年期间居住在丹麦的 40-59 岁的年龄范围内，共覆盖 17,754,788 人年。我们使用 Cox 比例风险和 Aalen 加性风险模型来估计 2 型糖尿病、教育程度和六种常见合并症（心血管疾病、癌症和脑血管疾病、呼吸系统疾病、肌肉骨骼疾病和精神疾病）的相对和绝对联合效应。我们将教育水平、2型糖尿病和合并症的联合效应分解为主效应和交互效应，以额外的残疾养老金案例来衡量。

结果

较低的受教育程度、2 型糖尿病和合并症独立地促成了额外授予的残疾养老金。残疾抚恤金的联合病例数超过了三种暴露的总和，这可以通过较低的教育水平、2型糖尿病和合并症的协同效应来解释。

结论/解释

在这项人群研究中，2 型糖尿病、受教育程度低和合并症的联合影响与残疾养老金的高于加和率有关。考虑到 2 型糖尿病康复的社会经济障碍的综合方法可能会减缓疾病进展并提高社会弱势群体的工作能力。

图形概要