David Flood1,2,3, Pascal Geldsetzer4,5, Kokou Agoudavi6, Krishna K Aryal7, Luisa Campos Caldeira Brant8,9, Garry Brian10, Maria Dorobantu11, Farshad Farzadfar12, Oana Gheorghe-Fronea11,13, Mongal Singh Gurung14, David Guwatudde15, Corine Houehanou16, Jutta M Adelin Jorgensen17, Dimple Kondal18,19, Demetre Labadarios20, Maja E Marcus21, Mary Mayige22, Mana Moghimi12, Bolormaa Norov23, Gastón Perman24, Sarah Quesnel-Crooks25, Mohammad-Mahdi Rashidi12, Sahar Saeedi Moghaddam26, Jacqueline A Seiglie27, Silver K Bahendeka28,29, Eric Steinbrook30, Michaela Theilmann31, Lisa J Ware32,33, Sebastian Vollmer21, Rifat Atun34,35, Justine I Davies36,37,38, Mohammed K Ali39,40, Peter Rohloff2,41, Jennifer Manne-Goehler42,43. 1. Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI. 2. Center for Indigenous Health Research, Wuqu' Kawoq, Tecpán, Guatemala. 3. Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala. 4. Division of Primary Care and Population Health, Stanford University, Stanford, CA. 5. Chan Zuckerberg Biohub, San Francisco, CA. 6. Togo Ministry of Health, Lome, Togo. 7. Public Health Promotion and Development Organization, Kathmandu, Nepal. 8. Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. 9. Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. 10. The Fred Hollows Foundation New Zealand, Auckland, New Zealand. 11. University of Medicine and Pharmacy Carol Davila, Bucharest, Romania. 12. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 13. Cardiology Department, Emergency Hospital Bucharest, Bucharest, Romania. 14. Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan. 15. Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda. 16. Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin. 17. Department of Public Health, University of Copenhagen, Copenhagen, Denmark. 18. Public Health Foundation of India, Gurugram, India. 19. Centre for Chronic Disease Control, New Delhi, India. 20. Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa. 21. Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany. 22. National Institute for Medical Research, Dar es Salaam, Tanzania. 23. Division of Nutrition, National Center for Public Health, Ulaanbaatar, Mongolia. 24. Department of Public Health, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. 25. Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago. 26. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 27. Diabetes Unit, Massachusetts General Hospital, Boston, MA. 28. Saint Francis Hospital Nsambya, Kampala, Uganda. 29. Uganda Martyrs University, Kampala, Uganda. 30. University of Michigan Medical School, Ann Arbor, MI. 31. Heidelberg Institute of Global Health, Heidelberg University and University Hospital, Heidelberg, Germany. 32. South African Medical Research Council-Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa. 33. Department of Science and Innovation-National Research Foundation Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa. 34. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA. 35. Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA. 36. Institute of Applied Health Research, University of Birmingham, Birmingham, U.K. 37. Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa. 38. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. 39. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. 40. Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA. 41. Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA. 42. Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 43. Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Abstract
OBJECTIVE: Diabetes prevalence is increasing rapidly in rural areas of low- and middle-income countries (LMICs), but there are limited data on the performance of health systems in delivering equitable and effective care to rural populations. We therefore assessed rural-urban differences in diabetes care and control in LMICs. RESEARCH DESIGN AND METHODS: We pooled individual-level data from nationally representative health surveys in 42 countries. We used Poisson regression models to estimate age-adjusted differences in the proportion of individuals with diabetes in rural versus urban areas achieving performance measures for the diagnosis, treatment, and control of diabetes and associated cardiovascular risk factors. We examined differences across the pooled sample, by sex, and by country. RESULTS: The pooled sample from 42 countries included 840,110 individuals (35,404 with diabetes). Compared with urban populations with diabetes, rural populations had ∼15-30% lower relative risk of achieving performance measures for diabetes diagnosis and treatment. Rural populations with diagnosed diabetes had a 14% (95% CI 5-22%) lower relative risk of glycemic control, 6% (95% CI -5 to 16%) lower relative risk of blood pressure control, and 23% (95% CI 2-39%) lower relative risk of cholesterol control. Rural women with diabetes had lower achievement of performance measures relating to control than urban women, whereas among men, differences were small. CONCLUSIONS: Rural populations with diabetes experience substantial inequities in the achievement of diabetes performance measures in LMICs. Programs and policies aiming to strengthen global diabetes care must consider the unique challenges experienced by rural populations.
OBJECTIVE: Diabetes prevalence is increasing rapidly in rural areas of low- and middle-income countries (LMICs), but there are limited data on the performance of health systems in delivering equitable and effective care to rural populations. We therefore assessed rural-urban differences in diabetes care and control in LMICs. RESEARCH DESIGN AND METHODS: We pooled individual-level data from nationally representative health surveys in 42 countries. We used Poisson regression models to estimate age-adjusted differences in the proportion of individuals with diabetes in rural versus urban areas achieving performance measures for the diagnosis, treatment, and control of diabetes and associated cardiovascular risk factors. We examined differences across the pooled sample, by sex, and by country. RESULTS: The pooled sample from 42 countries included 840,110 individuals (35,404 with diabetes). Compared with urban populations with diabetes, rural populations had ∼15-30% lower relative risk of achieving performance measures for diabetes diagnosis and treatment. Rural populations with diagnosed diabetes had a 14% (95% CI 5-22%) lower relative risk of glycemic control, 6% (95% CI -5 to 16%) lower relative risk of blood pressure control, and 23% (95% CI 2-39%) lower relative risk of cholesterol control. Rural women with diabetes had lower achievement of performance measures relating to control than urban women, whereas among men, differences were small. CONCLUSIONS: Rural populations with diabetes experience substantial inequities in the achievement of diabetes performance measures in LMICs. Programs and policies aiming to strengthen global diabetes care must consider the unique challenges experienced by rural populations.
Authors: Stephen R Cole; Robert W Platt; Enrique F Schisterman; Haitao Chu; Daniel Westreich; David Richardson; Charles Poole Journal: Int J Epidemiol Date: 2009-11-19 Impact factor: 7.196
Authors: Azadeh Zabetian; Isabelle M Sanchez; K M Venkat Narayan; Christopher K Hwang; Mohammed K Ali Journal: Diabetes Res Clin Pract Date: 2014-01-14 Impact factor: 5.602
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
Authors: Leanne Riley; Regina Guthold; Melanie Cowan; Stefan Savin; Lubna Bhatti; Timothy Armstrong; Ruth Bonita Journal: Am J Public Health Date: 2016-01 Impact factor: 9.308
Authors: Andrew Stokes; Kaitlyn M Berry; Zandile Mchiza; Whadi-Ah Parker; Demetre Labadarios; Lumbwe Chola; Charles Hongoro; Khangelani Zuma; Alana T Brennan; Peter C Rockers; Sydney Rosen Journal: PLoS One Date: 2017-10-02 Impact factor: 3.240