Trends in socio-economic inequalities on diabetes prevalence and management status in Korea, 2007-2017

당뇨병 유병률 및 관리 실태의 사회경제적 불평등 추세: 2007-2017 국민건강영양조사 분석

  • Shin, Ji-Yeon (Department of Preventive Medicine, School of Medicine, Kyungpook National University)
  • 신지연 (경북대학교 의과대학 예방의학교실)
  • Received : 2019.06.24
  • Accepted : 2019.08.20
  • Published : 2019.08.28


This study aimed to assess trends in the prevalence, treatment, and control of diabetes according to the socio-economic level in Korean adults aged ${\geq}30$ years, using the 2007-2017 Korea National Health and Nutrition Examination Survey data. Socio-economic status was assessed based on the household income. Multivariable logistic regression and predictive margins were used to evaluate the adjusted proportion of diabetes prevalence, awareness, treatment, and adequate glycemic control. During 2007-2017, the socio-economic inequalities on diabetes prevalence were observed in both men and women. However, the gradient of inequality increased only in men (p for interaction=0.034). Diabetes awareness, treatment, and control did not show socio-economic inequalities or increasing gradients in both sexes. Monitoring of these trends should be continued, and further research on effective interventions is needed.


Supported by : National Research Foundation of Korea (NRF)


  1. World Health Organization. (2016). Global report on diabetes. Geneva: World Health Organization.
  2. International Diabetes Federation. (2017). IDF diabetes atlas: eighth edition 2017. Brussels: International Diabetes Federation.
  3. Korea Centers for Disease Control and Prevention. (2017). Korea Health Statistics 2016: Korea National Health and Nutrition Examination Survey (KNHANES VII-1). Osong: Korea Centers for Disease Control and Prevention.
  4. E. Agardh, P. Allebeck, J. Hallqvist, T. Moradi & A. Sidorchuk. (2011). Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. International Journal of Epidemiology, 40(3), 804-818. DOI : 10.1093/ije/dyr029.
  5. A. Espelt, L. Arriola, C. Borrell, I. Larranaga, M. Sandin & A. Escolar-Pujolar. (2011). Socioeconomic position and type 2 diabetes mellitus in Europe 1999-2009: a panorama of inequalities. Current Diabetes Reviews, 7(3), 148-158. DOI : 10.2174/157339911795843131
  6. J. Hwang & C. Shon. (2014). Relationship between socioeconomic status and type 2 diabetes: results from Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012. BMJ open, 4(8), e005710. DOI : 10.1136/bmjopen-2014-005710
  7. Y. J. Kim, J. Y. Jeon, S. J. Han, H. J. Kim, K. W. Lee & D. J. Kim. (2015). Effect of socio-economic status on the prevalence of diabetes. Yonsei Medical Journal, 56(3), 641-647. DOI : 10.3349/ymj.2015.56.3.641
  8. G. R. Kim & C. M. Nam. (2017). Temporal trends in educational inequalities in non-communicable diseases in Korea, 2007-2015. PLoS One, 12(12), e0190143. DOI : 10.1371/journal.pone.0190143
  9. A. F. Brown et al. (2004). Socioeconomic position and health among persons with diabetes mellitus: a conceptual framework and review of the literature. Epidemiologic Reviews, 26, 63-77. DOI : 10.1093/epirev/mxh002
  10. Korea Centers for Disease Control and Prevention. (2019). The guideline for the usage of Korean National Health and Nutrition Survey raw data. Osong: Korea Centers for Disease Control and Prevention.
  11. S. Geyer, O. Hemstrom, R. Peter & D. Vagero. (2006). Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice. Journal of Epidemiology and Community Health, 60(9), 804-810. DOI : 10.1136/jech.2005.041319
  12. J. J. Chamberlain, A. S. Rhinehart, C. F. Shaefer & Jr., A. Neuman. (2016). Diagnosis and management of diabetes: synopsis of the 2016 American diabetes association standards of medical care in diabetes. Annals of Internal Medicine, 164(8), 542-552. DOI : 10.7326/M15-3016
  13. M. T. Crim et al. (2012). National surveillance definitions for hypertension prevalence and control among adults. Circulation: Cardiovascular Quality and Outcomes, 5(3), 343-351. DOI : 10.1161/CIRCOUTCOMES.111.963439
  14. B. I. Graubard & E. L. Korn. (1999). Predictive margins with survey data. Biometrics, 55(2), 652-659. DOI : 10.1111/j.0006-341X.1999.00652.x
  15. SAS Institute. (2014). SAS SAS/STAT(R) 9.22 User's Guide. SAS Institute.
  16. International Diabetes Federation. (2019). About diabetes. International Diabetes Federation.
  17. E. Blas & A. S. Kurup. (2010). Equity, social determinants and public health programmes. Chapter 5. Diabetes: equity and social determinants. Geneva: World Health Organization.
  18. A. K. Imkampe & M. C. Gulliford. (2011). Increasing socio-economic inequality in type 2 diabetes prevalence--repeated cross-sectional surveys in England 1994-2006. European Journal of Public Health, 21(4), 484-490. DOI : 10.1093/eurpub/ckq106
  19. A. Espelt, A. E. Kunst, L. Palencia, R. Gnavi & C. Borrell. (2012). Twenty years of socio-economic inequalities in type 2 diabetes mellitus prevalence in Spain, 1987-2006. European Journal of Public Health, 22(6), 765-771. DOI : 10.1093/eurpub/ckr158
  20. S. Scholes et al. (2012). Persistent socioeconomic inequalities in cardiovascular risk factors in England over 1994-2008: a time-trend analysis of repeated cross-sectional data. BMC Public Health, 14(12), 129. DOI : 10.1186/1471-2458-12-129
  21. I. H. Meyer, S. Schwartz & D. M. Frost. (2008). Social patterning of stress and coping: does disadvantaged social statuses confer more stress and fewer coping resources? Social Science & Medicine, 67(3), 368-379. DOI : 10.1016/j.socscimed.2008.03.012
  22. R. Rosmond & P. Bjorntorp. (2000). The hypothalamic-pituitary-adrenal axis activity as a predictor of cardiovascular disease, type 2 diabetes and stroke. Journal of Internal Medicine, 247(2), 188-197. DOI : 10.1046/j.1365-2796.2000.00603.x
  23. B. A. Neel & R. M. Sargis. (2011). The paradox of progress: environmental disruption of metabolism and the diabetes epidemic. Diabetes, 60(7), 1838-1848. DOI : 10.2337/db11-0153
  24. R. M. Sargis. (2014). The hijacking of cellular signaling and the diabetes epidemic: mechanisms of environmental disruption of insulin action and glucose homeostasis. Diabetes & metabolism journal, 38(1), 13-24. DOI : 10.4093/dmj.2014.38.1.13
  25. M. abu Sayeed, L. Ali, M. Z. Hussain, M. A. Rumi, A. Banu & A. K. Azad Khan. (1997). Effect of socioeconomic risk factors on the difference in prevalence of diabetes between rural and urban populations in Bangladesh. Diabetes Care, 20(4), 551-555. DOI : 10.2337/diacare.20.4.551
  26. R. P. Wilder, S. R. Majumdar, S. W. Klarenbach & P. Jacobs. (2005). Socio-economic status and undiagnosed diabetes. Diabetes Research and Clinical Practice, 70(1), 26-30. DOI : 10.1016/j.diabres.2005.02.008
  27. R. H. Glazier, J. Bajcar, N. R. Kennie & K. Willson. (2006). A systematic review of interventions to improve diabetes care in socially disadvantaged populations. Diabetes Care, 29(7), 1675-1688. DOI : 10.2337/dc05-1942
  28. M. I. Harris. (2001). Racial and ethnic differences in health care access and health outcomes for adults with type 2 diabetes. Diabetes Care, 24(3), 454-459. DOI : 10.2337/diacare.24.3.454