Socioeconomic Position and Health among Persons with Diabetes Mellitus: A Conceptual Framework and Review of the Literature

Abstract

There has been a resurgence of interest in the relation between health and socioeconomic position (SEP). SEP encompasses two important notions: the influence of the structural location of individuals and groups in a society and the cumulative effects of time. It addresses the context in which health-damaging exposures and health-protective resources act at different stages of the life course to influence adult health (1, 2). Such an approach provides a broad framework in which to think about and understand how both recent and remote socioeconomic factors interact to affect adult health. A substantial body of literature demonstrates that in the general population, material and social deprivation are directly related to disease incidence and prevalence and inversely related to health status (1, 3–8). Various studies have addressed the relation between lower SEP and mortality (9) or the development of chronic conditions (10–13) such as diabetes mellitus, cardiovascular disease, and cancer. Although some compelling evidence exists for an association between low SEP and adverse health outcomes for persons with diabetes and other chronic conditions, the pathways through which SEP and health are related in persons with chronic illness are poorly understood.