Burden of type 2 diabetes attributed to lower educational levels in Sweden

To include lower educational levels as a risk factor for type 2 diabetes, we pooled relevant international data from a recent systematic review to measure the association between type 2 diabetes incidence and lower educational levels. We also collected data on the distribution of educational levels in the Swedish population using comparable criteria for educational levels as identified in the international literature. Population attributable fractions (PAF) were estimated and applied to the burden of diabetes estimates from the Swedish burden of disease database for men and women in the separate age groups (30-44, 45-59, 60-69, 70-79, and 80+ years).The PAF estimates showed that 17.2% of the diabetes burden in men and 20.1% of the burden in women were attributed to lower educational levels in Sweden when combining all age groups. The burden was, however, most pronounced in the older age groups (70-79 and 80+), where lower educational levels contributed to 22.5% to 24.5% of the diabetes burden in men and 27.8% to 32.6% in women.There is a considerable burden of type 2 diabetes attributed to lower educational levels in Sweden, and socioeconomic indicators should be considered to be incorporated in the CRA.A considerable number of studies show that low socioeconomic position (SEP) is associated with disease, and socioeconomic inequalities in morbidity and mortality are highlighted as key concerns in many countries [1-4]. The World Health Organization (WHO) Comparative Risk Assessment (CRA) module of the Global Burden of Disease (GBD) study is widely used as a unified systematic approach to assess the contribution of selected risk factors to disease burden all over the world [5,6]. CRA includes 26 risk factors, mainly based on behavioral and medical risk factors such as physical inactivity, body mass index (BMI), smoking, blood pressure, and cholesterol. The included risk factors are selected on the basis of the following criteria: likely to be among the leading global