Diabetes Prevalence and Its Relationship With Education, Wealth, and BMI in 29 Low- and Middle-Income Countries
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Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
Diabetes Care
Abstract
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), lowermiddle-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.
Description
Keywords
Diabetes Prevalence, Education, Wealth, Low- and Middle-Income Countries
Citation
Seiglie, JA, Marcus, ME, Ebert, C., Prodromidis, N., Geldsetzer, P., Theilmann, M., ... & Manne-Goehler, J. (2020). Diabetes prevalence and its relationship with education, wealth, and BMI in 29 low-and middle-income countries. Diabetes Care , 43 (4), 767-775. https://doi.org/10.2337/dc19-1782