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There is a documented association between higher unemployment rates in inner cities and a higher risk of type 2 diabetes mellitus (DM) (1). Higher unemployment at regional level is also associated with a higher prevalence of diabetes mellitus (2). Possible causes for the relationship between unemployment and diabetes mellitus include, for example, limited financial resources, which can lead to underfunded support of physical activity and healthy diets (3, 4). Results from the DIAB-CORE Consortium, a study that examined, among other issues, the relationship between type 2 diabetes mellitus and various social aspects including unemployment in Germany (1, 2, 5), led us to question whether the relationship between unemployment rates and the incidence of diabetes mellitus could be confirmed for larger areas and over longer periods of time in the Czech Republic. We also wanted to determine whether previous findings of a study involving a relatively small sample of patients could be verified using a different methodology based on population data (official unemployment figures) from all 14 administrative regions of the Czech Republic.We analyzed the relationship between the incidence of diabetes mellitus and unemployment in the Czech Republic, wherein 10,509,286 inhabitants resided during 2012 and the prevalence of diabetes mellitus was 8.0%. The country is divided into 14 higher-level territorial administrative units (regions): in 2012 the least populous was inhabited by 301,726 residents, while the most populous by 1,291,816 residents (6). Data pertaining to patients with diabetes mellitus (more specifically, the number of new diabetes patients per calendar year) were obtained from a register that is maintained by the Institute of Health Information and Statistics of the Czech Republic, to which all physicians are legally obliged to annually report data for diabetes patients in their care (7). Unemployment figures were obtained from a register kept by the Ministry of Labour and Social Affairs, which is managed in accordance with Eurostat/International Labour Office methods (8). At the time this study was conducted, available data from both registers spanned the period from 2000 to 2012.Given that the unemployment rates among individual regions vary both instantaneously and continuously, we compared the relationship between unemployment rates and the incidence of diabetes mellitus, while taking into account time and inter-regional differences in both population totals and background diabetes incidence. Using the Generalized Additive Model (GAM) (9), regions were represented by i and calendar year was represented by t:(ProQuest: ... denotes formula omitted.)wherein the modeled quantity (the left side of the equation) is a proxy for the regionally-specific incidence. For this, the effect of unemployment was tested (regional and time-specific); coefficient β is estimated from the data, after an adjustment for regionallyspecific average incidence (μi) and time trend s(t) , estimated as a spline, and [varepsilon] it represents homoscedastic random error.Thus, we compared the incidence of diabetes mellitus and unemployment rate, while taking into account separate values for individual regions, over the aforementioned period of 2000-2012. The effect of unemployment on DM incidence adjusted for spatial and temporal differences was positive (the estimate of the β coefficient was 4.173.10-3, its standard error was 7.688.10-4 ) and highly statistically significant (p Unfortunately, the diabetes mellitus patient registry does not distinguish types of disease in the annual new patient reports. However, the number of patients registered according to different types of diabetes mellitus in the years 2000 and 2012 was 44,870 and 56,514 individuals, respectively, with type 1 diabetes mellitus: 8,299 and 12,128, respectively, with secondary diabetes; and 599,782 and 772,585, respectively, with type 2 diabetes mellitus. …

Incidence of Diabetes Mellitus Narrowly Correlates with Unemployment Rate during 2000-2012 in the Czech Republic