A systematic review and meta-analysis of the association between low socioeconomic status and all-cause mortality in patients with diabetes.

OBJECTIVE

The aim of this study was to evaluate the association between socioeconomic status (SES) and all-cause mortality among individuals with diabetes. We also examined how individual SES components, including income, employment, education, and housing conditions, were associated with mortality risk.

METHODS

Following PRISMA 2020 guidelines, we searched PubMed, Embase, the Cochrane Library, and Web of Science through September 2025. Eligible studies included adults with type 1 or type 2 diabetes reporting associations between SES indicators (income, education, occupation, or area-level deprivation) and all-cause mortality. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models based on heterogeneity (I2). Publication bias was assessed using funnel plots and Egger's test.

RESULTS

Nineteen studies were included. Low SES was associated with a higher risk of all-cause mortality (OR = 1.67; 95% CI: 1.49-1.88; p < 0.00001). Similar associations were observed across income, education, housing, and employment domains. Heterogeneity was substantial (I 2 = 99%), indicating considerable variability across studies. Sensitivity analyses showed that no single study materially influenced the pooled estimate, and publication bias appeared minimal.

CONCLUSION

Low socioeconomic status is associated with increased mortality among individuals with diabetes. Addressing socioeconomic inequalities through improved access to education, employment opportunities, healthy environments, and equitable healthcare may help reduce survival disparities and mitigate the overall burden of diabetes.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1248984, identifier PROSPERO (CRD420251248984).