Widening educational inequalities in type 2 diabetes risk and mediators across successive generations: a prospective cohort study.
4 affiliations
- 1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Tongzhou, Beijing, China.
- 2National Clinical Research Center for Cardiovascular Disease, Tongzhou, Beijing, China.
- 3Beijing Institute of Heart, Lung and Blood Vessel Diseases, Tongzhou, Beijing, China.
- 4Department of Epidemiology and Biostatistics, School of Basic Medicine, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Abstract
Background
Lower educational attainment has been associated with incident T2DM and adverse outcomes among people with established diabetes, but these stages have largely been studied separately. Whether education-related inequalities span the trajectory from T2DM onset to subsequent cardiovascular disease (CVD) and death, and whether these inequalities differ across birth cohorts, remains uncertain.Methods
This study included participants from the UK Biobank who were free of diabetes at baseline. Participants were stratified into three birth cohorts (pre-1949, 1950-1959, and post-1960) to investigate intergenerational differences in educational inequalities. We employed Fine-Gray proportional subdistribution hazards models and multi-state competing risks models to evaluate the impact of education on the risk of incident T2DM and its subsequent progression to cardiovascular disease (CVD) and mortality. The Relative Index of Inequality (RII) was calculated to quantify the magnitude of disparities. Pathway analysis was conducted to estimate the extent to which socioeconomic, behavioral, and metabolic factors explained the association between educational attainment and T2DM risk.Results
During a median follow-up of 16.5 years, 19,931 incident cases of T2DM were documented among the 460,797 included participants. Primary education or less was associated with increased risks of incident T2DM (HR 1.92, 1.85-1.99), progression to CVD (HR 1.33, 1.30-1.37), and mortality (HR 1.53, 1.49-1.57) compared with college education, and these disparities widened across successive birth cohorts. Overall, the adjusted RII was 2.37 (2.25-2.50), increasing from 2.31 (2.16-2.47) in the pre-1949 cohort to 2.53 (2.29-2.79) in the 1950-1959 cohort and 2.53 (2.18-2.93) in the post-1960 cohort. Socioeconomic, metabolic, and behavioral factors mediated a substantial proportion of the educational inequality, accounting for 42.2% (39.2%-45.2%), 42.6% (38.2%-47.3%), and 20.5% (18.9%-22.2%), respectively.Conclusion
Education-related inequalities extend from T2DM incidence to subsequent progression and have widened across successive birth cohorts. Socioeconomic, behavioral, and metabolic factors mediated a substantial proportion of these disparities.
Related
- Socioeconomic position, adverse childhood experiences, and menstrual symptoms in two generations of a prospective UK cohort.
- Educational inequalities in incidence and mortality trends of four common cancers in Finland
- Sex and educational inequalities across functional ability trajectories in Chile: A sequence analysis of a 17-year national panel
- Childhood educational, social and health factors associated with the timing and recurrence of NEET status into adulthood: a prospective birth cohort study
- European innovation alliance for musculoskeletal health literacy in the digital era (Digi4MSK project): protocol for a prospective multi-country two parallel evaluation of digital educational interventions for musculoskeletal health literacy
BibTeX
@article{zhao2026widening,
title = {{Widening educational inequalities in type 2 diabetes risk and mediators across successive generations: a prospective cohort study.}},
author = {Zehao Zhao and Mengge Zhou and Changsheng Ma and Tianyi Wang and Libo Zhao and Xiliang Zhao and Quan Li and Yaodong Ding and Yang Zhang and Li Lin and Wenjie Wang and Jiayi Han and Yingxun Bai and Yong Zeng},
journal = {Frontiers in public health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1893269},
url = {https://europepmc.org/article/MED/42903079},
note = {CC BY},
}
RIS
TY - JOUR
TI - Widening educational inequalities in type 2 diabetes risk and mediators across successive generations: a prospective cohort study.
AU - Zehao Zhao
AU - Mengge Zhou
AU - Changsheng Ma
AU - Tianyi Wang
AU - Libo Zhao
AU - Xiliang Zhao
AU - Quan Li
AU - Yaodong Ding
AU - Yang Zhang
AU - Li Lin
AU - Wenjie Wang
AU - Jiayi Han
AU - Yingxun Bai
AU - Yong Zeng
PY - 2026
DA - 2026/10/06
JO - Frontiers in public health
DO - 10.3389/fpubh.2026.1893269
UR - https://europepmc.org/article/MED/42903079
AB - Background Lower educational attainment has been associated with incident T2DM and adverse outcomes among people with established diabetes, but these stages have largely been studied separately. Whether education-related inequalities span the trajectory from T2DM onset to subsequent cardiovascular disease (CVD) and death, and whether these inequalities differ across birth cohorts, remains uncertain.Methods This study included participants from the UK Biobank who were free of diabetes at baseline. Participants were stratified into three birth cohorts (pre-1949, 1950-1959, and post-1960) to investigate intergenerational differences in educational inequalities. We employed Fine-Gray proportional subdistribution hazards models and multi-state competing risks models to evaluate the impact of education on the risk of incident T2DM and its subsequent progression to cardiovascular disease (CVD) and mortality. The Relative Index of Inequality (RII) was calculated to quantify the magnitude of disparities. Pathway analysis was conducted to estimate the extent to which socioeconomic, behavioral, and metabolic factors explained the association between educational attainment and T2DM risk.Results During a median follow-up of 16.5 years, 19,931 incident cases of T2DM were documented among the 460,797 included participants. Primary education or less was associated with increased risks of incident T2DM (HR 1.92, 1.85-1.99), progression to CVD (HR 1.33, 1.30-1.37), and mortality (HR 1.53, 1.49-1.57) compared with college education, and these disparities widened across successive birth cohorts. Overall, the adjusted RII was 2.37 (2.25-2.50), increasing from 2.31 (2.16-2.47) in the pre-1949 cohort to 2.53 (2.29-2.79) in the 1950-1959 cohort and 2.53 (2.18-2.93) in the post-1960 cohort. Socioeconomic, metabolic, and behavioral factors mediated a substantial proportion of the educational inequality, accounting for 42.2% (39.2%-45.2%), 42.6% (38.2%-47.3%), and 20.5% (18.9%-22.2%), respectively.Conclusion Education-related inequalities extend from T2DM incidence to subsequent progression and have widened across successive birth cohorts. Socioeconomic, behavioral, and metabolic factors mediated a substantial proportion of these disparities.
SN - 2296-2565
ER -