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


Journal article


Jacqueline A. Seiglie, Maja-Emilia Marcus, Cara Ebert, Nikolaos Prodromidis, Pascal Geldsetzer, Michaela Theilmann, Kokou Agoudavi, Glennis Andall-Brereton, Krishna K. Aryal, Brice Wilfried Bicaba, Pascal Bovet, Garry Brian, Maria Dorobantu, Gladwell Gathecha, Mongal Singh Gurung, David Guwatudde, Mohamed Msaidié, Corine Houehanou, Dismand Houinato, Jutta Mari Adelin Jorgensen, Gibson B. Kagaruki, Khem B. Karki, Demetre Labadarios, Joao S. Martins, Mary T. Mayige, Roy Wong-McClure, Joseph Kibachio Mwangi, Omar Mwalim, Bolormaa Norov, Sarah Quesnel-Crooks, Bahendeka K. Silver, Lela Sturua, Lindiwe Tsabedze, Chea Stanford Wesseh, Andrew Stokes, Rifat Atun, Justine I. Davies, Sebastian Vollmer, Till W. Bärnighausen, Lindsay M. Jaacks, James B. Meigs, Deborah J. Wexler, Jennifer Manne-Goehler
Diabetes Care, vol. 43, 2020 Apr, pp. 767--775

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APA
Seiglie, J. A., Marcus, M.-E., 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, 767–775.

Chicago/Turabian
Seiglie, Jacqueline A., Maja-Emilia Marcus, Cara Ebert, Nikolaos Prodromidis, Pascal Geldsetzer, Michaela Theilmann, Kokou Agoudavi, et al. “Diabetes Prevalence and Its Relationship With Education, Wealth, and BMI in 29 Low- and Middle-Income Countries.” Diabetes Care 43 (April 2020): 767–775.

MLA
Seiglie, Jacqueline A., et al. “Diabetes Prevalence and Its Relationship With Education, Wealth, and BMI in 29 Low- and Middle-Income Countries.” Diabetes Care, vol. 43, Apr. 2020, pp. 767–75.


Abstract

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.

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