Social Inequalities and Diabetes:
How Does Place of Residence Influence the Severity of Complications?
by Péter Elek
Diabetes is one of the most widespread chronic diseases globally, and its complications pose serious consequences for both individuals and healthcare systems. A new study from Hungary, authored by Péter Elek, Balázs Mayer, and Orsolya Varga, reveals a strong connection between the severity of diabetes-related complications and the socioeconomic characteristics of where patients live—particularly the local unemployment rate.
We utilized comprehensive administrative health data on all diagnosed diabetes patients in Hungary between 2010 and 2017 and measured the severity of complications using the adapted Diabetes Complications Severity Index (aDCSI).
Higher Unemployment, More Severe Complications
The study found that the average aDCSI score among diabetes patients was 1.6. Cardiovascular complications were the most common, occurring in 41% of cases, followed by ophthalmic, cerebrovascular, and neurological complications, which ranged between 14% and 24%.
A central result of the study is that in municipalities where the unemployment rate exceeds the national median, both the prevalence of diabetes and the severity of its complications are higher. Specifically, a one percentage point increase in the local unemployment rate was associated with a 2.1% rise in the average aDCSI score.
These results remained robust after controlling for age group, gender, diabetes type (Type 1 or Type 2), and various healthcare access indicators—including the availability of general practitioners, specialist outpatient care hours per capita, hospital bed supply—as well as settlement type, the proportion of residents with a university degree, and per capita income.
Complications and Mortality
We also investigated the relationship between local unemployment and mortality among diabetes patients. We found that a one percentage point increase in the local unemployment rate raised the five-year in-hospital mortality risk of diabetes patients by 1%, even when accounting for age, gender, and diabetes type. When including measures of complication severity or frequency in the models, the estimated impact on mortality decreased, suggesting that complications play a mediating role. Among these, kidney, cardiovascular and peripheral vascular complications were particularly associated with higher mortality risk.
Health Risks Behind Social Inequalities
One of the study’s key takeaways is that socioeconomic disadvantage not only increases the risk of developing diabetes but also worsens the progression of the disease. Patients living in higher-unemployment areas are likely to receive a diagnosis later, have poorer access to quality care, and consequently face a greater risk of developing severe complications.
Based on these findings, we suggest that greater attention should be directed toward diabetes patients in economically deprived regions. Strengthening both primary and specialist care in these areas could be a crucial step toward reducing health disparities related to diabetes.
Péter Elek, Balázs Mayer, Orsolya Varga
Socioeconomic inequalities and diabetes complications: an analysis of administrative data from Hungary
European Journal of Public Health, 2025
https://doi.org/10.1093/eurpub/ckaf038
