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 Click to copy
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 Click to copy
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 Click to copy
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.

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@article{seiglie2020a,
  title = {Diabetes Prevalence and Its Relationship With Education, Wealth, and BMI in 29 Low- and Middle-Income Countries},
  year = {2020},
  month = apr,
  journal = {Diabetes Care},
  pages = {767--775},
  volume = {43},
  author = {Seiglie, Jacqueline A. and Marcus, Maja-Emilia and Ebert, Cara and Prodromidis, Nikolaos and Geldsetzer, Pascal and Theilmann, Michaela and Agoudavi, Kokou and Andall-Brereton, Glennis and Aryal, Krishna K. and Bicaba, Brice Wilfried and Bovet, Pascal and Brian, Garry and Dorobantu, Maria and Gathecha, Gladwell and Gurung, Mongal Singh and Guwatudde, David and Msaidié, Mohamed and Houehanou, Corine and Houinato, Dismand and Jorgensen, Jutta Mari Adelin and Kagaruki, Gibson B. and Karki, Khem B. and Labadarios, Demetre and Martins, Joao S. and Mayige, Mary T. and Wong-McClure, Roy and Mwangi, Joseph Kibachio and Mwalim, Omar and Norov, Bolormaa and Quesnel-Crooks, Sarah and Silver, Bahendeka K. and Sturua, Lela and Tsabedze, Lindiwe and Wesseh, Chea Stanford and Stokes, Andrew and Atun, Rifat and Davies, Justine I. and Vollmer, Sebastian and Bärnighausen, Till W. and Jaacks, Lindsay M. and Meigs, James B. and Wexler, Deborah J. and Manne-Goehler, Jennifer},
  month_numeric = {4}
}

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.

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

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