Inequalities in diabetes and related risk factors: Comparing Canadian adults by income level 

Diabetes is a chronic health condition in which the body cannot produce or process insulin, leading to issues in glucose (sugar) regulation. There are three types of diabetes. Type 2 is the most common¹. Other types include type 1 and gestational diabetes, which occurs during pregnancy.

Here we describe income inequalities in self-reported chronic disease risk factors as well as self-reported diabetes, looking specifically at type 1 and type 2 diabetes combined, excluding gestational diabetes².

Diabetes prevalence

The prevalence of diabetes is 2.1 times higher among adults living in the lowest income group, compared to those living in the highest income group³.

Overall, men are 1.5 times more likely to have diabetes than women. However, inequalities in diabetes prevalence rates observed between lowest and highest income groups are more pronounced for women⁴.

Table 1 –Prevalence (%) of diabetes, by income and by sex

	Women	Men
Quintile 1 (lowest)	9.2*	12.4*
Quintile 2	7.0*	9.5*
Quintile 3	5.6*	9.1*
Quintile 4	4.8*	8.2*
Quintile 5 (highest) (reference)	3.4	6.3

*: Significantly different from reference category

Source: Canadian Community Health Survey 2015-16, 2017-18

Chronic conditions – risk factors

Inequalities persist between income groups in self-reported risk factors for chronic conditions.

Hypertension

• The proportion of people with high blood pressure in the lowest income group is 1.3 times higher than that in the highest income group.
• This corresponds to 5 more people per 100 in the lowest income group that have high blood pressure, compared to the highest income group.

Obesity

• Compared to the highest income group, obesity prevalence is 1.2 times higher among the lowest income group.
• For women, the income inequality is larger. There are 9 more women with obesity in the lowest income group compared to the highest income group, per 100 people.

Cigarette smoking

• Adults in the lowest income group are 2.1 times more likely to smoke, compared to adults in the highest income group.
• This corresponds to 13 more people per 100 in the lowest income group that smoked, compared to the highest income group.

Heavy alcohol consumption

• Among both men and women, heavy alcohol consumption increases with income.
• For every 100 people, there are 13 more people with heavy alcohol consumption in the highest income group, compared to the lowest.

Physical activity

Meeting the Canadian Physical Activity Guidelines' recommended level of physical activity (at least 150 minutes of moderate to vigorous physical activity per week, in bouts of 10 minutes or more) can help reduce the risk of chronic conditions.

Income level can influence one's capacity to meet this recommendation⁵⁶. Income inequalities affect access to recreational and green spaces, safe built environment, and competing demands on personal time, for work or caregiving⁵⁶. All these factors influence physical activity.

Table 2 – Percentage (%) of adults who report meeting Canadian guidelines for physical activity, by income and by sex

	Women	Men
Quintile 1 (lowest)	47.5*	50.8*
Quintile 2	50.0*	55.9*
Quintile 3	53.3*	59.0*
Quintile 4	56.1*	64.8*
Quintile 5 (highest) (reference)	60.6	68.2

*: Significantly different from reference category

Source: Canadian Community Health Survey 2015-16, 2017-18

Fruit and vegetable consumption

The consumption of fruits and vegetables can reduce the risk of chronic conditions. Fruit and vegetable consumption at least 5 times per day is influenced in part by food security - that is, one's income capacity to purchase the variety or quantity of food they need ².

• Across all income levels, fruit and vegetable consumption is lower among men, compared to women
• For both sexes, the association between fruit and vegetable consumption and income follows a gradient, with higher prevalence of fruit and vegetable consumption among higher income groups.
• This gradient is strongest for women: The prevalence of women in the lowest income group is 0.7 times that of women in the highest income group – compared to a ratio of 0.8 for men.

Table 3 – Percentage (%) of adults who report consuming fruit and vegetable at least 5 times per day, by income and by sex

	Women	Men
Quintile 1 (lowest)	31.0*	20.6*
Quintile 2	36.4*	21.3*
Quintile 3	37.8*	24.5
Quintile 4	40.6*	24.2
Quintile 5 (highest) (reference)	44.6	25.4

*: Significantly different from reference category

Source: Canadian Community Health Survey 2015-16

Inequalities in diabetes risk are driven in part by social determinants of health, including inequalities in income, social support or built environment⁷. These determinants influence opportunities and access to health promoting resources, including access to health care, food security and healthy eating and physical activity⁷.

To view these data and others on health inequalities in Canada, visit: https://health-infobase.canada.ca/health-inequalities/data-tool/

To explore the latest data on diabetes incidence, prevalence and all-cause mortality in Canada, visit: https://health-infobase.canada.ca/ccdss/data-tool/