Socioeconomic inequalities in multimorbidity among individuals with diabetes in European countries

Abstract Background Diabetes mellitus (DM) often coexists with multiple chronic conditions, leading to reduced quality of life and complicating disease management. As DM prevalence rises, there is a growing need to understand patterns of multimorbidity and their association with socioeconomic status (SES) to inform effective interventions. The study aims to describe the multimorbidity pattern among individuals with DM and to explore SES-related inequalities across European countries. Methods This cross-sectional study used data from wave 8 (2019/2020) of the Survey of Health, Ageing and Retirement in Europe (SHARE). The total sample included 6,330 adults aged 50 years and older with DM across 25 EU countries. Multimorbidity was defined as the co-occurrence of two or more common chronic conditions alongside DM. SES was assessed through income, wealth and education. Absolute and relative inequalities in multimorbidity were measured using the slope index of inequality and concentration index. Results Among individuals with DM, the prevalence of multimorbidity was 65.7%. Hypertension (66.1%) and high blood cholesterol (40.8%) were the most frequent coexisting conditions, followed by osteoarthritis (23.7%). Multimorbidity was more prevalent among individuals in the lowest income (73.4%, p < 0.001) and wealth quartiles (73.3%, p < 0.001). A marked age-related rise in multimorbidity prevalence was observed in Central and Eastern Europe and Southern Europe, increasing from 47.4% to 83.6% and from 44.1% to 81.3% between the 55-59 and 80+ age groups. Absolute and relative inequality measures showed that multimorbidity is more concentrated among those with lower socioeconomic status. Conclusions Our findings suggest that lower SES is linked to a higher burden of multimorbidity among people with DM. Addressing these disparities requires tailored healthcare approaches that consider the complex effect of coexisting chronic conditions and broader social determinants of health. Key messages • People living in Southern and Central and Eastern Europe suffer from greater multimorbidity burden. • Reducing socioeconomic disparities is key to easing the burden of diabetes-related multimorbidity.