Soc Sci Med. 2026 Jun 23;404:119519. doi: 10.1016/j.socscimed.2026.119519. Online ahead of print.
ABSTRACT
BACKGROUND: Type 2 diabetes (T2DM) and depression often co-occur, generating substantial health burdens. Social determinants may shape vulnerability to both conditions. Using a syndemic framework, this study examines the clustering of T2DM, depression, education, and place of birth in a large cohort in Piedmont, Italy.
METHODS: We analysed 861,300 males and 917,545 females aged 45-75 years from the Piedmont Longitudinal Study. T2DM and depression were identified from electronic health records; education was classified into three levels, and place of birth as Italy/high-income countries (HIC) versus low- and middle-income countries (LMIC). Latent class analysis identified patterns of clustering. Cox proportional hazards models estimated associations of latent classes (LC) with emergency room (ER) access and all-cause mortality over five years.
RESULTS: Three LC were identified in both sexes. In both, the class with high comorbidity and low education had the poorest outcomes. Among males, this group had 31% higher ER use (95% CI 1.29-1.33) and 60% higher mortality (95% CI 1.55-1.66) than the reference. Among females, risks were 30% higher for ER use (95% CI 1.28-1.33) and 43% higher for mortality (95% CI 1.37-1.49). Migration background influenced outcomes differently: males from LMIC had lower mortality without higher ER use, while females showed slightly higher ER use but lower mortality.
CONCLUSIONS: T2DM and depression cluster with low educational level, with patterns differing by sex and migration background. The syndemic framework highlights the need for integrated interventions addressing both conditions and social determinants to promote health equity.
PMID:42364280 | DOI:10.1016/j.socscimed.2026.119519
