Jacqueline A Seiglie1,2, Maja-Emilia Marcus3, Cara Ebert3, Nikolaos Prodromidis3, Pascal Geldsetzer4, Michaela Theilmann5, Kokou Agoudavi6, Glennis Andall-Brereton7, Krishna K Aryal8, Brice Wilfried Bicaba9, Pascal Bovet10,11, Garry Brian12, Maria Dorobantu13, Gladwell Gathecha14, Mongal Singh Gurung15, David Guwatudde16, Mohamed Msaidié17, Corine Houehanou18, Dismand Houinato18, Jutta Mari Adelin Jorgensen19, Gibson B Kagaruki20, Khem B Karki21, Demetre Labadarios22, Joao S Martins23, Mary T Mayige20, Roy Wong-McClure24, Joseph Kibachio Mwangi14,25, Omar Mwalim26, Bolormaa Norov27, Sarah Quesnel-Crooks7, Bahendeka K Silver28, Lela Sturua29, Lindiwe Tsabedze30, Chea Stanford Wesseh31, Andrew Stokes32, Rifat Atun33,34, Justine I Davies35,36, Sebastian Vollmer3, Till W Bärnighausen5,33,37, Lindsay M Jaacks33,38, James B Meigs39, Deborah J Wexler40,2, Jennifer Manne-Goehler41. 1. Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA jseiglie@partners.org. 2. Department of Medicine, Harvard Medical School, Boston, MA. 3. Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany. 4. Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA. 5. Institute of Global Health, Heidelberg University, Heidelberg, Germany. 6. Ministry of Health, Lome, Togo. 7. Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago. 8. Nepal Health Research Council, Kathmandu, Nepal. 9. Institut Africain de Santé publique, Ouagadougou, Burkina Faso. 10. Ministry of Health, Victoria, Republic of Seychelles. 11. University Center for Primary Care and Public Health, Lausanne, Switzerland. 12. The Fred Hollows Foundation NZ, Auckland, New Zealand. 13. Cardiology Department, Emergency Hospital of Bucharest, Bucharest, Romania. 14. Division of Non-Communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya. 15. Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan. 16. Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda. 17. Comoros Ministry of Health, Solidarity, Social Cohesion and Gender, Moroni, Comoros. 18. Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin. 19. Partners In Health, Boston, MA. 20. National Institute for Medical Research, Dar es Salaam, Tanzania. 21. Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal. 22. Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa. 23. Faculty of Medicine and Health Sciences, National University of East Timor, Dili, Timor-Leste. 24. Epidemiology Office and Surveillance, Caja Costarricense de Seguro Social, San Jose, Costa Rica. 25. Faculté de médecine, Université de Genève, Geneva, Switzerland. 26. Zanzibar Ministry of Health, Mnazi Mmoja, Zanzibar. 27. National Center for Public Health, Ulaanbaatar, Mongolia. 28. St. Francis Hospital, Nsambya, Kampala, Uganda. 29. Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia. 30. Swaziland Ministry of Health, Mbabane, Swaziland. 31. Liberia Ministry of Health, Monrovia, Liberia. 32. Center for Global Health and Development, Boston University, Boston, MA. 33. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA. 34. Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA. 35. MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, Johannesburg, South Africa. 36. Institute of Applied Health Research, University of Birmingham, Birmingham, U.K. 37. Africa Health Research Institute, Somkhele, South Africa. 38. Public Health Foundation of India, New Delhi, India. 39. Department of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 40. Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 41. Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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.
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.
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Authors: Jennifer Manne-Goehler; Pascal Geldsetzer; Kokou Agoudavi; Glennis Andall-Brereton; Krishna K Aryal; Brice Wilfried Bicaba; Pascal Bovet; Garry Brian; Maria Dorobantu; Gladwell Gathecha; Mongal Singh Gurung; David Guwatudde; Mohamed Msaidie; Corine Houehanou; Dismand Houinato; Jutta Mari Adelin Jorgensen; Gibson B Kagaruki; Khem B Karki; Demetre Labadarios; Joao S Martins; Mary T Mayige; Roy Wong McClure; Omar Mwalim; Joseph Kibachio Mwangi; Bolormaa Norov; Sarah Quesnel-Crooks; Bahendeka K Silver; Lela Sturua; Lindiwe Tsabedze; Chea Stanford Wesseh; Andrew Stokes; Maja Marcus; Cara Ebert; Justine I Davies; Sebastian Vollmer; Rifat Atun; Till W Bärnighausen; Lindsay M Jaacks Journal: PLoS Med Date: 2019-03-01 Impact factor: 11.069
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Authors: David Flood; Jacqueline A Seiglie; Matthew Dunn; Scott Tschida; Michaela Theilmann; Maja E Marcus; Garry Brian; Bolormaa Norov; Mary T Mayige; Mongal Singh Gurung; Krishna K Aryal; Demetre Labadarios; Maria Dorobantu; Bahendeka K Silver; Pascal Bovet; Jutta M Adelin Jorgensen; David Guwatudde; Corine Houehanou; Glennis Andall-Brereton; Sarah Quesnel-Crooks; Lela Sturua; Farshad Farzadfar; Sahar Saeedi Moghaddam; Rifat Atun; Sebastian Vollmer; Till W Bärnighausen; Justine I Davies; Deborah J Wexler; Pascal Geldsetzer; Peter Rohloff; Manuel Ramírez-Zea; Michele Heisler; Jennifer Manne-Goehler Journal: Lancet Healthy Longev Date: 2021-05-21
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