Premium
Association between area‐ and individual‐level socio‐economic factors with glycated haemoglobin—Evidence from a Portuguese population‐based study
Author(s) -
SousaUva Mafalda,
Barreto Marta,
Roquette Rita,
MatiasDias Carlos,
Ribeiro Rogério,
Manuel Boavida José,
Nunes Baltazar
Publication year - 2021
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.14542
Subject(s) - medicine , portuguese , glycated hemoglobin , confidence interval , demography , gerontology , multilevel model , environmental health , diabetes mellitus , type 2 diabetes , statistics , endocrinology , philosophy , linguistics , mathematics , sociology
Aims This study aims to estimate the associations between area‐level deprivation and individual‐level socio‐economic factors, as well as their interaction, with glycated haemoglobin (HbA 1c ) levels. Methods We conducted a gamma multilevel regression analysis using individual‐level data from the Portuguese National Health Examination Survey and a deprivation index built through factor analysis, at municipality level, with census variables. Results Living in a municipality with high material deprivation and having a low level of education were independently associated with an increase of 2.3% (95% confidence interval [CI] 0.6, 4.0) and of 1.6% (95% CI 0.6, 2.7) in the mean levels of HbA 1c , respectively. The interaction between area material deprivation and individual‐level education was not associated with the levels of HbA 1c (0.5%, 95% CI −1.3, 2.3). Conclusions Our findings support the collective resources model that argues that people in less deprived areas have better health because there are more collective resources. The results suggest that to reduce socio‐economic inequalities associated with the levels of HbA 1c and, consequently, with diabetes, will require attention to the area material deprivation and individual‐level education. Upstream social determinants of health are thus highlighted.