Variations in Diabetes Prevalence in Low-, Middle-, and High-Income Countries: Results From the Prospective Urban and Rural Epidemiological Study

Dagenais GR 1 , Gerstein HC 2 , Zhang X 2 , McQueen M 2 , Lear S 3 , Lopez-Jaramillo P 4 Show all authors , Mohan V 5 , Mony P 6 , Gupta R 7 , Kutty VR 8 , Kumar R 9 , Rahman O 10 , Yusoff K 11 , Zatonska K 12 , Oguz A 13 , Rosengren A 14 , Kelishadi R 15 , Yusufali A 16 , Diaz R 17 , Avezum A 18 , Lanas F 19 , Kruger A 20 , Peer N 21 , Chifamba J 22 , Iqbal R 23 , Ismail N 24 , Xiulin B 25 , Jiankang L 26 , Wenqing D 27 , Gejie Y 28 , Rangarajan S 2 , Teo K 2 , Yusuf S 2

Affiliations 

  • 1 Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, Canada gilles.dagenais@criucpq.ulaval.ca
  • 2 Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
  • 3 Faculty of Health Sciences, Simon Fraser University, and Healthy Heart Program, St. Paul's Hospital, Vancouver, British Columbia, Canada
  • 4 Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia
  • 5 Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
  • 6 Division of Epidemiology, Biostatistics and Population Health, St. John's Research Institute, Bangalore, India
  • 7 Fortis Escorts Hospital, Malviya Nagar, Jaipur, India
  • 8 Health Action by People, Thiruvananthapuram, Kerala, India
  • 9 PGIMER School of Public Health, Chandigarh, India
  • 10 Independent University, Bangladesh, Bashundhara, Dhaka, Bangladesh
  • 11 Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia UCSI University, Cheras, Selangor, Malaysia
  • 12 Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
  • 13 Faculty of Medicine, Department of Internal Medicine, Istanbul Medeniyet University, Istanbul, Turkey
  • 14 Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital/Östra, Göteborg, Sweden
  • 15 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  • 16 Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
  • 17 Estudios Clínicos Latinoamérica, Rosario, Argentina
  • 18 Dante Pazzanese Institute of Cardiology, São Paulo, São Paulo, Brazil
  • 19 Universidad de La Frontera, Temuco, Chile
  • 20 Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
  • 21 Non-communicable Diseases Research Unit, South African Medical Research Council, Durban, KwaZulu-Natal, South Africa Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
  • 22 Physiology Department, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
  • 23 Departments of Community Health Sciences and Medicine, The Aga Khan University, Karachi, Pakistan
  • 24 Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
  • 25 Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, FuWai Hospital, Beijing, China
  • 26 Jianshe Road Community Health Center, Chengdu City, Sichuan Province, China
  • 27 Health Center, Dayicaichang Town, Sichuan Province, China
  • 28 Qiluhuayuan Hospital, Jinan City, Shandong Province, China
Diabetes Care, 2016 05;39(5):780-7.
PMID: 26965719 DOI: 10.2337/dc15-2338

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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