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

被引：123

作者：

Seiglie, Jacqueline A. ^{[1
,2
]}

Marcus, Maja-Emilia ^{[3
,4
]}

Ebert, Cara ^{[3
,4
]}

Prodromidis, Nikolaos ^{[3
,4
]}

Geldsetzer, Pascal ^{[5
]}

Theilmann, Michaela ^{[6
]}

Agoudavi, Kokou ^{[7
]}

Andall-Brereton, Glennis ^{[8
]}

Aryal, Krishna K. ^{[9
]}

Bicaba, Brice Wilfried ^{[10
]}

Bovet, Pascal ^{[11
,12
]}

Brian, Garry ^{[13
]}

Dorobantu, Maria ^{[14
]}

Gathecha, Gladwell ^{[15
]}

Gurung, Mongal Singh ^{[16
]}

Guwatudde, David ^{[17
]}

Msaidie, Mohamed ^{[18
]}

Houehanou, Corine ^{[19
]}

Houinato, Dismand ^{[19
]}

Jorgensen, Jutta Mari Adelin ^{[20
]}

Kagaruki, Gibson B. ^{[21
]}

Karki, Khem B. ^{[22
]}

Labadarios, Demetre ^{[23
]}

Martins, Joao S. ^{[24
]}

Mayige, Mary T. ^{[21
]}

Wong-McClure, Roy ^{[25
]}

Mwangi, Joseph Kibachio ^{[15
,26
]}

Mwalim, Omar ^{[27
]}

Norov, Bolormaa ^{[28
]}

Quesnel-Crooks, Sarah ^{[8
]}

Silver, Bahendeka K. ^{[29
]}

Sturua, Lela ^{[30
]}

Tsabedze, Lindiwe ^{[31
]}

Wesseh, Chea Stanford ^{[32
]}

Stokes, Andrew ^{[33
]}

Atun, Rifat ^{[34
,35
]}

Davies, Justine I. ^{[36
,37
]}

Vollmer, Sebastian ^{[3
,4
]}

Baernighausen, Till W. ^{[6
,34
,38
]}

Jaacks, Lindsay M. ^{[34
,39
]}

Meigs, James B. ^{[40
]}

Wexler, Deborah J. ^{[1
,2
]}

Manne-Goehler, Jennifer ^{[41
]}

机构：

[1] Harvard Med Sch, Massachusetts Gen Hosp, Diabet Unit, Boston, MA 02115 USA

[2] Harvard Med Sch, Dept Med, Boston, MA 02115 USA

[3] Univ Gottingen, Dept Econ, Gottingen, Germany

[4] Univ Gottingen, Ctr Modern Indian Studies, Gottingen, Germany

[5] Stanford Univ, Dept Med, Div Primary Care & Populat Hlth, Stanford, CA 94305 USA

[6] Heidelberg Univ, Inst Global Hlth, Heidelberg, Germany

[7] Minist Hlth, Lome, Togo

[8] Caribbean Publ Hlth Agcy, Noncommunicable Dis, Port Of Spain, Trinidad Tobago

[9] Nepal Hlth Res Council, Kathmandu, Nepal

[10] Inst Africain Sante Publ, Ouagadougou, Burkina Faso

[11] Minist Hlth, Victoria, Seychelles

[12] Univ Ctr Primary Care & Publ Hlth, Lausanne, Switzerland

[13] Fred Hollows Fdn NZ, Auckland, New Zealand

[14] Emergency Hosp Bucharest, Cardiol Dept, Bucharest, Romania

[15] Kenya Minist Hlth, Div Noncommunicable Dis, Nairobi, Kenya

[16] Minist Hlth, Hlth Res & Epidemiol Unit, Thimphu, Bhutan

[17] Makerere Univ, Sch Publ Hlth, Dept Epidemiol & Biostat, Kampala, Uganda

[18] Comoros Minist Hlth Solidar Social Cohes & Gender, Moroni, Comoros

[19] Univ Abomey Calavi, Lab Epidemiol Chron & Neurol Dis, Fac Hlth Sci, Cotonou, Benin

[20] Partners Hlth, Boston, MA USA

[21] Natl Inst Med Res, Dar Es Salaam, Tanzania

[22] Tribhuvan Univ, Inst Med, Dept Community Med & Publ Hlth, Kathmandu, Nepal

[23] Stellenbosch Univ, Fac Med & Hlth Sci, Stellenbosch, South Africa

[24] Natl Univ East Timor, Fac Med & Hlth Sci, Dili, Timor-Leste

[25] Caja Costarricense Seguro Social, Epidemiol Off & Surveillance, San Jose, Costa Rica

[26] Univ Geneva, Fac Med, Geneva, Switzerland

[27] Zanzibar Minist Hlth, Mnazi Mmoja, Zanzibar, Tanzania

[28] Natl Ctr Publ Hlth, Ulaanbaatar, Mongolia

[29] St Francis Hosp, Kampala, Uganda

[30] Natl Ctr Dis Control & Publ Hlth, Noncommunicable Dis Dept, Tbilisi, Georgia

[31] Swaziland Minist Hlth, Mbabane, Eswatini

[32] Liberia Minist Hlth, Monrovia, Liberia

[33] Boston Univ, Ctr Global Hlth & Dev, Boston, MA 02215 USA

[34] Harvard Univ, Harvard TH Chan Sch Publ Hlth, Dept Global Hlth & Populat, Boston, MA 02115 USA

[35] Harvard Univ, Harvard Med Sch, Dept Global Hlth & Social Med, Boston, MA 02115 USA

[36] Univ Witwatersrand, MRC Wits Rural Publ Hlth & Hlth Transit Res Unit, Sch Publ Hlth, Johannesburg, South Africa

[37] Univ Birmingham, Inst Appl Hlth Res, Birmingham, W Midlands, England

[38] Africa Hlth Res Inst, Somkhele, South Africa

[39] Publ Hlth Fdn India, New Delhi, India

[40] Harvard Med Sch, Massachusetts Gen Hosp, Dept Gen Internal Med, Boston, MA 02115 USA

[41] Harvard Med Sch, Massachusetts Gen Hosp, Div Infect Dis, Boston, MA 02115 USA

来源：

DIABETES CARE | 2020年 / 43卷 / 04期

基金：

美国国家卫生研究院;

关键词：

SOCIOECONOMIC POSITION; HEALTH; MELLITUS; OBESITY; TRENDS; RISK;

D O I：

10.2337/dc19-1782

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：767 / 775

页数：9

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