Diabetes Prevalence and Its Relationship With Education, Wealth, and BMI in 29 Low- and Middle-Income Countries - PubMed (original) (raw)

. 2020 Apr;43(4):767-775.

doi: 10.2337/dc19-1782. Epub 2020 Feb 12.

Maja-Emilia Marcus 3, Cara Ebert 3, Nikolaos Prodromidis 3, Pascal Geldsetzer 4, Michaela Theilmann 5, Kokou Agoudavi 6, Glennis Andall-Brereton 7, Krishna K Aryal 8, Brice Wilfried Bicaba 9, Pascal Bovet 10 11, Garry Brian 12, Maria Dorobantu 13, Gladwell Gathecha 14, Mongal Singh Gurung 15, David Guwatudde 16, Mohamed Msaidié 17, Corine Houehanou 18, Dismand Houinato 18, Jutta Mari Adelin Jorgensen 19, Gibson B Kagaruki 20, Khem B Karki 21, Demetre Labadarios 22, Joao S Martins 23, Mary T Mayige 20, Roy Wong-McClure 24, Joseph Kibachio Mwangi 14 25, Omar Mwalim 26, Bolormaa Norov 27, Sarah Quesnel-Crooks 7, Bahendeka K Silver 28, Lela Sturua 29, Lindiwe Tsabedze 30, Chea Stanford Wesseh 31, Andrew Stokes 32, Rifat Atun 33 34, Justine I Davies 35 36, Sebastian Vollmer 3, Till W Bärnighausen 5 33 37, Lindsay M Jaacks 33 38, James B Meigs 39, Deborah J Wexler 40 2, Jennifer Manne-Goehler 41

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Diabetes Prevalence and Its Relationship With Education, Wealth, and BMI in 29 Low- and Middle-Income Countries

Jacqueline A Seiglie et al. Diabetes Care. 2020 Apr.

Abstract

Objective: Diabetes is a rapidly growing health problem in low- and middle-income countries (LMICs), but empirical data on its prevalence and relationship to socioeconomic status are scarce. We estimated diabetes prevalence and the subset with undiagnosed diabetes in 29 LMICs and evaluated the relationship of education, household wealth, and BMI with diabetes risk.

Research design and methods: We pooled individual-level data from 29 nationally representative surveys conducted between 2008 and 2016, totaling 588,574 participants aged ≥25 years. Diabetes prevalence and the subset with undiagnosed diabetes was calculated overall and by country, World Bank income group (WBIG), and geographic region. Multivariable Poisson regression models were used to estimate relative risk (RR).

Results: Overall, prevalence of diabetes in 29 LMICs was 7.5% (95% CI 7.1-8.0) and of undiagnosed diabetes 4.9% (4.6-5.3). Diabetes prevalence increased with increasing WBIG: countries with low-income economies (LICs) 6.7% (5.5-8.1), lower-middle-income economies (LMIs) 7.1% (6.6-7.6), and upper-middle-income economies (UMIs) 8.2% (7.5-9.0). Compared with no formal education, greater educational attainment was associated with an increased risk of diabetes across WBIGs, after adjusting for BMI (LICs RR 1.47 [95% CI 1.22-1.78], LMIs 1.14 [1.06-1.23], and UMIs 1.28 [1.02-1.61]).

Conclusions: Among 29 LMICs, diabetes prevalence was substantial and increased with increasing WBIG. In contrast to the association seen in high-income countries, diabetes risk was highest among those with greater educational attainment, independent of BMI. LMICs included in this analysis may be at an advanced stage in the nutrition transition but with no reversal in the socioeconomic gradient of diabetes risk.

© 2020 by the American Diabetes Association.

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Figures

Figure 1

Figure 1

Country-level prevalence of total diabetes and the subset with undiagnosed diabetes in 29 population-based surveys conducted between 2008 and 2016, by World Bank income classification. Country classification at time of survey according to World Bank gross national income per capita in USD (Atlas methodology). Prevalence accounts for complex survey sampling design. Values are not adjusted for age and sex. Overall prevalence estimated with sampling weights scaled such that each country contributed proportionally to its population size. Unable to estimate undiagnosed diabetes prevalence for Ecuador, given no information available on diabetes diagnosis self-report in the Ecuador ENSANUT 2012 survey.

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