Diabetes Metab J.  2024 Mar;48(2):290-301. 10.4093/dmj.2022.0299.

Risk of Depression according to Cumulative Exposure to a Low-Household Income Status in Individuals with Type 2 Diabetes Mellitus: A Nationwide Population- Based Study

• Park SH
• Lee YB
• Lee Kn
• Kim B
• Cho SH
• Kwon SY
• Park J
• Kim G
• Jin SM
• Hur KY
• Han K
• Kim JH

• KMID: 2553599
• DOI: http://doi.org/10.4093/dmj.2022.0299

Abstract

Background
We aimed to identify the risk of incident depression according to cumulative exposure to a low-household income status in individuals with type 2 diabetes mellitus (T2DM).
Methods
For this retrospective longitudinal population-based cohort study, we used Korean National Health Insurance Service data from 2002 to 2018. Risk of depression was assessed according to cumulative exposure to low-household income status (defined as Medical Aid registration) during the previous 5 years among adults (aged ≥20 years) with T2DM and without baseline depression who underwent health examinations from 2009 to 2012 (n=2,027,317).
Results
During an average 6.23 years of follow-up, 401,175 incident depression cases occurred. Advance in cumulative number of years registered for medical aid during the previous 5 years from baseline was associated with an increased risk of depression in a dose-dependent manner (hazard ratio [HR], 1.44 [95% confidence interval (CI), 1.38 to 1.50]; HR, 1.40 [95% CI, 1.35 to 1.46]; HR, 1.42, [95% CI, 1.37 to 1.48]; HR, 1.46, [95% CI, 1.40 to 1.53]; HR, 1.69, [95% CI, 1.63 to 1.74] in groups with 1 to 5 exposed years, respectively). Insulin users exposed for 5 years to a low-household income state had the highest risk of depression among groups categorized by insulin use and duration of low-household income status.
Conclusion
Cumulative duration of low-household income status, defined as medical aid registration, was associated with an increased risk of depression in a dose-response manner in individuals with T2DM.

Keyword

Depression; Diabetes mellitus, type 2; Income; Social class

Figure

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  Fig. 1. Cumulative incidence of depression according to the number of years of exposure to a low-household income.

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  Fig. 2. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for depression in subjects exposed or not exposed to a low-household income status in subgroups. Adjusted for age, sex, smoking history, alcohol consumption, regular exercise, presence of chronic kidney disease, fasting plasma glucose, diabetes duration (≥5 years vs. <5 years), and presence of mental, behavioral and neurodevelopmental disease, cancer, dementia. MFM, metformin; SU, sulfonylurea; TZD, thiazolidinedione; DPP4i, dipeptidyl peptidase-4 inhibitor.

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  Fig. 3. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for depression according to 12 groups categorized by insulin use and the number of years of exposure to a low-household income. Adjusted for age, sex, smoking history, alcohol consumption, regular exercise, presence of chronic kidney disease, fasting plasma glucose, diabetes duration (≥5 years vs. <5 years), presence of mental, behavioral and neurodevelopmental disease, cancer, dementia, and use of metformin and sulfonylurea.

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