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. 2013 Mar 6;3(3):e002436.
doi: 10.1136/bmjopen-2012-002436.

Self-rated health and type 2 diabetes risk in the European Prospective Investigation into Cancer and Nutrition-InterAct study: a case-cohort study

Patrik Wennberg  1 , Olov Rolandsson, Daphne L van der A, Annemieke M W Spijkerman, Rudolf Kaaks, Heiner Boeing, Silke Feller, Manuela M Bergmann, Claudia Langenberg, Stephen J Sharp, Nita Forouhi, Elio Riboli, Nicholas Wareham
Affiliations

Self-rated health and type 2 diabetes risk in the European Prospective Investigation into Cancer and Nutrition-InterAct study: a case-cohort study

Patrik Wennberg et al. BMJ Open. .

Abstract

Objectives: To investigate the association between self-rated health and risk of type 2 diabetes and whether the strength of this association is consistent across five European centres.

Design: Population-based prospective case-cohort study.

Setting: Enrolment took place between 1992 and 2000 in five European centres (Bilthoven, Cambridge, Heidelberg, Potsdam and Umeå).

Participants: Self-rated health was assessed by a baseline questionnaire in 3399 incident type 2 diabetic case participants and a centre-stratified subcohort of 4619 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct study which was drawn from a total cohort of 340 234 participants in the EPIC.

Primary outcome measure: Prentice-weighted Cox regression was used to estimate centre-specific HRs and 95% CIs for incident type 2 diabetes controlling for age, sex, centre, education, body mass index (BMI), smoking, alcohol consumption, energy intake, physical activity and hypertension. The centre-specific HRs were pooled across centres by random effects meta-analysis.

Results: Low self-rated health was associated with a higher hazard of type 2 diabetes after adjusting for age and sex (pooled HR 1.67, 95% CI 1.48 to 1.88). After additional adjustment for health-related variables including BMI, the association was attenuated but remained statistically significant (pooled HR 1.29, 95% CI 1.09 to 1.53). I(2) index for heterogeneity across centres was 13.3% (p=0.33).

Conclusions: Low self-rated health was associated with a higher risk of type 2 diabetes. The association could be only partly explained by other health-related variables, of which obesity was the strongest. We found no indication of heterogeneity in the association between self-rated health and type 2 diabetes mellitus across the European centres.

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Figures

Figure 1
Figure 1
Overview of the five centres included in the study from the European Prospective Investigation into Cancer and Nutrition-InterAct study.
Figure 2
Figure 2
Centre-specific and pooled HRs of incident type 2 diabetes mellitus adjusted for the variables in the final model (age, sex, education, body mass index, smoking, physical activity, alcohol consumption, energy intake and hypertension).
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