ArticleDiabetologia2026
Inequalities in type 2 diabetes incidence in a multiethnic population: a cohort study investigating the impact of ethnicity, migration and mental health comorbidities.
Article in Diabetologia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aims/hypothesisEthnic disparities in the incidence of type 2 diabetes mellitus are well documented in multiethnic urban populations, but the contributions of migration status and mental health are less well understood. This study used a large dataset from primary care centres in South London that is unique in that it includes migration-related information together with information on mental and physical health comorbidities. We aimed to assess how migration status and mental health contribute to longitudinal associations of ethnicity and type 2 diabetes risk in a multiethnic urban population.
methodsWe conducted a longitudinal cohort study (2012-2019) of approximately 340,000 adults without baseline type 2 diabetes. Cox proportional hazards models were applied with sequential adjustments: first for age and sex; second, adding migration status (country of birth being UK or not); and third, further adding mental health conditions (depression, anxiety, severe mental illness), physical health factors (BMI, hypertension and other macrovascular diseases) and area-level deprivation. This approach allowed us to examine whether ethnic differences in the incidence of type 2 diabetes persist after accounting for additional factors.
resultsSouth Asian, Black African and Black Caribbean groups had 2-3-fold higher type 2 diabetes risks compared with White British individuals, which were only partially explained by socioeconomic and clinical factors. Being born outside the UK increased type 2 diabetes risk by 29% across all ethnic groups. Depression/anxiety and severe mental illness were associated with a higher risk of type 2 diabetes. No statistical evidence of strong interactions between these factors was obtained. CONCLUSIONS/
interpretationEthnicity, migration status and mental health conditions were each independently associated with type 2 diabetes risk, and ethnic disparities persisted after adjustment. The lack of evidence for interactions suggests that migration- and mental health-related mechanisms may operate similarly across ethnic groups rather than amplifying or mitigating existing disparities in type 2 diabetes rates. Efforts to reduce diabetes inequalities will require both support for post‑migration challenges and addressing of the broader structural and environmental determinants underlying persistent ethnic disparities.
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