Socioeconomic disparities in diabetes risk: An exploration of income inequality and urbanization in Indonesia

Diabetes affects more than 800 million adults worldwide in 2024, with socioeconomic disparities exacerbating this epidemic. Adopting a life-course perspective, this study examined how early-life experiences, such as childhood hunger, intersect with adult socioeconomic and environmental factors to shape diabetes risk. This cross-sectional study constructs a simultaneous equation group model to empirically test the relationship between income inequality, urbanization, and diabetes (HbA1c) in Indonesia. A sample of 4503 individuals aged ≥15 years old in the 2014 Indonesian Family Life Survey (IFLS5) was recruited. Associations between variables were investigated using a path analysis run on STATA 13. Path modeling indicated that income inequality was indirectly associated with HbA1c levels through increased trans-fat consumption (β = 0.16; 95% CI = 0.13 to 0.19; p < 0.001) and elevated body mass index (β = 0.03; 95% CI = 0.01 to 0.6; p = 0.049), compounded by urban living (β = 0.12; 95% CI = 0.09 to 0.15; p < 0.001). Age, sex, history of childhood hunger, BMI, physical activity, and access to blood sugar monitoring facilities were directly associated with diabetes. Our findings underscore the need for multifaceted interventions addressing socioeconomic disparities, promoting healthy diets, and encouraging physical activity, particularly in urban areas, to mitigate the diabetes epidemic in low-middle-income countries.