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

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...

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Published in:Diabetes care Vol. 43; no. 4; p. 767
Main Authors: Seiglie, Jacqueline A, Marcus, Maja-Emilia, Ebert, Cara, Prodromidis, Nikolaos, Geldsetzer, Pascal, Theilmann, Michaela, Agoudavi, Kokou, Andall-Brereton, Glennis, Aryal, Krishna K, Bicaba, Brice Wilfried, Bovet, Pascal, Brian, Garry, Dorobantu, Maria, Gathecha, Gladwell, Gurung, Mongal Singh, Guwatudde, David, Msaidié, Mohamed, Houehanou, Corine, Houinato, Dismand, Jorgensen, Jutta Mari Adelin, Kagaruki, Gibson B, Karki, Khem B, Labadarios, Demetre, Martins, Joao S, Mayige, Mary T, Wong-McClure, Roy, Mwangi, Joseph Kibachio, Mwalim, Omar, Norov, Bolormaa, Quesnel-Crooks, Sarah, Silver, Bahendeka K, Sturua, Lela, Tsabedze, Lindiwe, Wesseh, Chea Stanford, Stokes, Andrew, Atun, Rifat, Davies, Justine I, Vollmer, Sebastian, Bärnighausen, Till W, Jaacks, Lindsay M, Meigs, James B, Wexler, Deborah J, Manne-Goehler, Jennifer
Format: Journal Article
Language:English
Published: United States 01.04.2020
Subjects:
Adult
Aged
Aged, 80 and over
Body Mass Index
Cross-Sectional Studies
Developing Countries - statistics & numerical data
Diabetes Mellitus - economics
Diabetes Mellitus - epidemiology
Educational Status
Female
Humans
Income - statistics & numerical data
Male
Middle Aged
Poverty - statistics & numerical data
Prevalence
Social Class
Social Determinants of Health - economics
Social Determinants of Health - statistics & numerical data
Socioeconomic Factors
ISSN:1935-5548, 1935-5548
Online Access:Get more information
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Summary: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. 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). 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]). 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.
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ISSN:1935-5548
1935-5548
DOI:10.2337/dc19-1782