Title

Variations in diabetes prevalence in low-, middle-, and high-income countries: results from the prospective urban and rural epidemiological study.

Authors

Gilles R. Dagenais, Université Laval, Quebec, Canada
Hertzel C. Gerstein, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
Xiaohe Zhang, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
Matthew McQueen, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
Scott Lear, St. Paul's Hospital, Vancouver, British Columbia, Canada
Patricio Lopez-Jaramillo, Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia
Viswanathan Mohan, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
Prem Mony, St. John’s Research Institute, Bangalore, India
Rajeev Gupta, Fortis Escorts Hospital, Malviya Nagar, Jaipur, India
V. Raman Kutty, Health Action by People, Thiruvananthapuram, Kerala, India
Rajesh Kumar, PGIMER School of Public Health, Chandigarh, India
Omar Rahman, Independent University, Bangladesh, Bashundhara, Dhaka, Bangladesh
Khalid Yusoff, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
Katarzyna Zatonska, Wroclaw Medical University, Wroclaw, Poland
Aytekin Oguz, Istanbul Medeniyet University, Istanbul, Turkey
Annika Rosengren, University of Gothenburg, and Sahlgrenska University Hospital/Östra, Göteborg, Sweden
Roya Kelishadi, Isfahan University of Medical Sciences, Isfahan, Iran
Afzalhussein Yusufali, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
Rafael Diaz, Estudios Clínicos Latinoamérica, Rosario, Argentina
Alvaro Avezum, Dante Pazzanese Institute of Cardiology, São Paulo, São Paulo, Brazil
Fernando Lanas, Universidad de La Frontera, Temuco, Chile
Annamarie Kruger, North-West University, Potchefstroom, South Africa
Nasheeta Peer, South African Medical Research Council, Durban, KwaZulu-Natal, South Africa
Jephat Chifamba, University of Zimbabwe, Harare, Zimbabwe
Romaina Iqbal, Aga Khan UniversityFollow
Noorhassim Ismail, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
Bai Xiulin, FuWai Hospital, Beijing, China
Liu Jiankang, Jianshe Road Community Health Center, Chengdu City, Sichuan Province, China
Deng Wenqing, Health Center, Dayicaichang Town, Sichuan Province, China
Yue Gejie, Qiluhuayuan Hospital, Jinan City, Shandong Province, China
Sumathy Rangarajan, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
Koon Teo, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
Salim Yusuf, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada

Document Type

Article

Department

Community Health Sciences

Abstract

OBJECTIVE:

The goal of this study was to assess whether diabetes prevalence varies by countries at different economic levels and whether this can be explained by known risk factors.

RESEARCH DESIGN AND METHODS:

The prevalence of diabetes, defined as self-reported or fasting glycemia ≥7 mmol/L, was documented in 119,666 adults from three high-income (HIC), seven upper-middle-income (UMIC), four lower-middle-income (LMIC), and four low-income (LIC) countries. Relationships between diabetes and its risk factors within these country groupings were assessed using multivariable analyses.

RESULTS:

Age- and sex-adjusted diabetes prevalences were highest in the poorer countries and lowest in the wealthiest countries (LIC 12.3%, UMIC 11.1%, LMIC 8.7%, and HIC 6.6%; P < 0.0001). In the overall population, diabetes risk was higher with a 5-year increase in age (odds ratio 1.29 [95% CI 1.28-1.31]), male sex (1.19 [1.13-1.25]), urban residency (1.24 [1.11-1.38]), low versus high education level (1.10 [1.02-1.19]), low versus high physical activity (1.28 [1.20-1.38]), family history of diabetes (3.15 [3.00-3.31]), higher waist-to-hip ratio (highest vs. lowest quartile; 3.63 [3.33-3.96]), and BMI (≥35 vs. <25 kg/m(2); 2.76 [2.52-3.03]). The relationship between diabetes prevalence and both BMI and family history of diabetes differed in higher- versus lower-income country groups (P for interaction < 0.0001). After adjustment for all risk factors and ethnicity, diabetes prevalences continued to show a gradient (LIC 14.0%, LMIC 10.1%, UMIC 10.9%, and HIC 5.6%).

CONCLUSIONS:

Conventional risk factors do not fully account for the higher prevalence of diabetes in LIC countries. These findings suggest that other factors are responsible for the higher prevalence of diabetes in LIC countries.

Publication

Diabetes Care