Spatial inequalities of diabetes-related mortality by gender

Abstract

The article examines diabetes as a growing public health issue in Hungary, where cases tripled in two decades, affecting one in six Hungarians. Geographical disparities in diabetes mortality are analyzed, highlighting how both individual factors (education, economic status) and community-level factors (service availability, healthcare access) contribute to these inequalities. The research explores gender differences in diabetes outcomes, with women facing higher cardiovascular risks despite better healthcare utilization. Previous findings linked service availability and alcohol-related mortality to diabetes mortality rates across districts. DATA ANDMETHODS: The analysis was carried out across 197 Hungarian microregions (LAU1/NUTS4).Variables analyzed include gender-specific diabetes mortality rates, socioeconomic factors(education, taxpayers), measures of territorial deprivation (food access, services), indicators of health behaviour (BMI, alcohol-related mortality), and healthcare system characteristics(physician availability, pharmacy access, specialist hours, hospital beds, medication modernity, preventive care). OLS linear regression was applied as the main methodology to analyze these variables individually, in blocks, and in combinations to understand geographic disparities in diabetes mortality between men and women.

Key findings of the study are that territorial deprivation strongly correlates with diabetes mortality of both genders, but men are more affected by food accessibility while women are by service availability. Alcohol-related mortality is a significant predictor for both genders, with men's alcohol consumption strongly affecting also women's diabetes mortality. Socioeconomic status (especially education levels) particularly influences women's mortality. Healthcare access variables lose significance when controlling for socioeconomic factors, suggesting inequalities stem primarily from social determinants rather than healthcare access.

Healthcare capacity and quality variables show week or no relationship with diabetes mortality, while territorial deprivation (particularly limited food access) strongly impacts mortality rates for both genders. Alcohol-related mortality emerged as the strongest predictor across all models. Several explanations can be proposed for this connection: biological interactions between diabetes and alcohol, poorer self-management among alcohol users, healthcare stigma, and family-level impacts where one person's alcoholism creates stress, reduces support, and causes financial strain for the entire household. Women's diabetes mortality was more influenced by socioeconomic status than men's.

Individual and territorial deprivation and alcohol consumption – especially among men –are significantly associated with diabetes mortality across genders. The models applied have moderate explanatory power, suggesting that not all factors influencing diabetes mortality at the regional level were identified. A notable finding is the strong correlation between diabetes mortality and alcohol-related deaths of the opposite gender, particularly for women. We interpret this as reflecting stress levels, lack of personal support, and financial constraints. While district level data conceals some relationships, it enables population-level analysis that wouldn't be possible through individual surveys.