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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a longitudinal cohort study (2012\u20132019) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>South Asian, Black African and Black Caribbean groups had 2\u20133-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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>Ethnicity, 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\u2011migration challenges and addressing of the broader structural and environmental determinants underlying persistent ethnic disparities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-026-06740-3","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T12:16:39Z","timestamp":1776860199000},"page":"2240-2252","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Inequalities in type 2 diabetes incidence in a multiethnic population: a cohort study investigating the impact of ethnicity, migration and mental health comorbidities"],"prefix":"10.1007","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2434-3641","authenticated-orcid":false,"given":"Diana","family":"Shamsutdinova","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7987-6619","authenticated-orcid":false,"given":"Daniel","family":"Stahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3913-6859","authenticated-orcid":false,"given":"Jayati","family":"Das-Munshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"issue":"1","key":"6740_CR1","doi-asserted-by":"publisher","first-page":"dyad182","DOI":"10.1093\/ije\/dyad182","volume":"53","author":"C Antini","year":"2024","unstructured":"Antini C, Caixeta R, Luciani S, Hennis AJM (2024) Diabetes mortality: trends and multi-country analysis of the Americas from 2000 to 2019. 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Accessed 14 Aug 2025"}],"container-title":["Diabetologia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00125-026-06740-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00125-026-06740-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00125-026-06740-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T19:00:20Z","timestamp":1782586820000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00125-026-06740-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,22]]},"references-count":52,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["6740"],"URL":"https:\/\/doi.org\/10.1007\/s00125-026-06740-3","relation":{},"ISSN":["0012-186X","1432-0428"],"issn-type":[{"value":"0012-186X","type":"print"},{"value":"1432-0428","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,22]]},"assertion":[{"value":"14 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"We acknowledge the contributions of Professor Mark Ashworth, King\u2019s College London, to the data extraction and initial discussions on the study's aims and design. Sadly, Professor Ashworth passed away in 2024, prior to substantial revisions to the study design and manuscript preparation. As a result, we were unable to seek his approval for the final version or his agreement to be accountable for all aspects of the work. Consequently, we could not include him as a co-author, but we recognise his highly valued contributions to the early stages of this research and his generous contributions to the field.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Acknowledgements"}},{"value":"The datasets generated and\/or analysed during the current study are not publicly available due to restrictions on use of the data for the approved researchers and projects only. The data are therefore available from the authors on request, subject to obtaining project-specific data access approvals from the NHS South East London Integrated Care System (SE London ICS [\n                      \n                      ]) and in accordance with recent guidelines from the Lambeth DataNet [\n                      \n                      ].","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data availability"}},{"value":"This study is funded by the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre (BRC). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. DSt and DSh received financial support from the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust (NIHR203318) and King\u2019s College London. JD-M received funding from the ESRC through the Centre for Society and Mental Health at King\u2019s College London (ESRC reference: ES\/S012567\/1) and is in receipt of funding from UK Research and Innovation for the Population Mental Health Consortium (grant number MR\/Y030788\/1), which is part of Population Health Improvement UK (PHI UK), a national research network that works to transform health and reduce inequalities through change at the population level.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 relationships and activities"}},{"value":"All authors contributed to the conceptualisation of the work, methodological approach, interpretation of the results, and critically reviewed and edited the manuscript drafts. In addition, DSh was responsible for the original draft, methodology, data preparation and formal analysis, JD-M was responsible for the data access and extraction, funding acquisition, study design and analysis supervision, and DSt was responsible for the conceptualisation and methodological supervision. All authors edited and approved the final version of the manuscript and gave consent for publication. DSh is the guarantor of this work and is responsible for the integrity of the work as a whole.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}}]}}