Contrasting associations between diabetes and cardiovascular mortality rates in low-, middle-, and high-income countries: Cohort study data from 143,567 individuals in 21 countries in the pure study

Ranjit Mohan Anjana, Viswanathan Mohan, Sumathy Rangarajan, Hertzel C. Gerstein, Ulagamadesan Venkatesan, Patrick Sheridan, Gilles R. Dagenais, Scott A. Lear, Koon Teo, Kubilay Karsidag, Khalid F. Alhabib, Khalid Yusoff, Noorhassim Ismail, Prem K. Mony, Patricio Lopez-Jaramillo, Jephat Chifamba, Lia M. Palileo-Villanueva, Romaina Iqbal, Afzalhussein Yusufali, Iolanthe M. KrugerAnnika Rosengren, Ahmad Bahonar, Katarzyna Zatonska, Karen Yeates, Rajeev Gupta, Wei Li, Lihua Hu, M. Omar Rahman, P. V.M. Lakshmi, Thomas Iype, Alvaro Avezum, Rafael Diaz, Fernando Lanas, Salim Yusuf

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)

Abstract

OBJECTIVE We aimed to compare cardiovascular (CV) events, all-cause mortality, and CV mortality rates among adults with and without diabetes in countries with differing levels of income. RESEARCH DESIGN AND METHODS The Prospective Urban Rural Epidemiology (PURE) study enrolled 143,567 adults aged 35–70 years from 4 high-income countries (HIC), 12 middle-income countries (MIC), and 5 low-income countries (LIC). The mean follow-up was 9.0 ± 3.0 years. RESULTS Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1,000 person-years, P < 0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1,000 person-years, P < 0.001), and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1,000 person-years, P < 0.001) were considerably higher in LIC compared with MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, and high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioral risk factors and treatments (hazard ratio [95% CI] 1.89 [1.58–2.27] to 1.78 [1.36–2.34]). CONCLUSIONS CVD rates, all-cause mortality, and CV mortality were markedly higher among those with diabetes in LIC compared with MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society.

Original languageEnglish
Pages (from-to)3094-3101
Number of pages8
JournalDiabetes Care
Volume43
Issue number12
DOIs
Publication statusPublished - 2020

Fingerprint

Dive into the research topics of 'Contrasting associations between diabetes and cardiovascular mortality rates in low-, middle-, and high-income countries: Cohort study data from 143,567 individuals in 21 countries in the pure study'. Together they form a unique fingerprint.

Cite this