Association between urbanisation and type 2 diabetes: an ecological study - PubMed (original) (raw)

Association between urbanisation and type 2 diabetes: an ecological study

Zakariah Gassasse et al. BMJ Glob Health. 2017.

Abstract

Introduction: Previous studies have explored the effect of urbanisation on the prevalence of type 2 diabetes (T2D) at regional/national level. The aim of this study is to investigate the association between urbanisation and T2D at country level, worldwide, and to explore the role of intermediate variables (physical inactivity, sugar consumption and obesity). The potential effect modification of gross domestic product (GDP) was also assessed.

Methods: Data for 207 countries were collected from accessible datasets. Direct acyclic graphs were used to describe the association between urbanisation, T2D and their intermediate variables (physical inactivity, sugar consumption and obesity). Urbanisation was measured as urban percentage (UP) and as agglomeration index (AI). Crude and multivariate linear regression analyses were conducted to explore selected associations. The interaction between urbanisation and T2D across levels of GDP per capita was investigated.

Results: The association between urbanisation and T2D diverged by exposure: AI was positively associated, while UP negatively associated with T2D prevalence. Physical inactivity and obesity were statistically significantly associated with increased prevalence of T2D. In middle-income countries (MIC) UP, AI and GDP were significantly associated with T2D prevalence, while in high-income countries (HIC), physical inactivity and obesity were the main determinant of T2D prevalence.

Conclusions: The type of urban growth, not urbanisation per se, predicted T2D prevalence at country level. In MIC, population density and GDP were the main determinant of diabetes, while in HIC. these were physical inactivity and obesity. Globalisation is playing an important role in the rise of T2D worldwide.

Keywords: descriptive study; environmental health; epidemiology; nutrition; public health.

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Figures

Figure 1

Figure 1

A conceptual framework disentangling the reciprocal associations of the variables used in the analysis, using the directed acyclic graph. In orange, the association that were found significant statistically in the multivariate models (table 1). AI, agglomeration index; T2D, type 2 diabetes.

Figure 2

Figure 2

Maps showing the age-adjusted prevalence of T2D as proportion of the total population aged 20–79 years in 2015, worldwide (A); urban proportion, as proportion of total population at country level living in urban areas, worldwide (B); agglomeration index at country levels, worldwide (C). T2D, type 2 diabetes.

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