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

Gilles R. Dagenais, Hertzel C. Gerstein, Xiaohe Zhang, Matthew McQueen, Scott Lear, Patricio Lopez-Jaramillo, Viswanathan Mohan, Prem Mony, Rajeev Gupta, V. Raman Kutty, Rajesh Kumar, Omar Rahman, Khalid Yusoff, Katarzyna Zatonska, Aytekin Oguz, Annika Rosengren, Roya Kelishadi, Afzalhussein Yusufali, Rafael Diaz, Alvaro AvezumFernando Lanas, Annamarie Kruger, Nasheeta Peer, Jephat Chifamba, Romaina Iqbal, Noorhassim Ismail, Bai Xiulin, Liu Jiankang, Deng Wenqing, Yue Gejie, Sumathy Rangarajan, Koon Teo, Salim Yusuf

Research output: Contribution to journalArticlepeer-review

132 Citations (Scopus)

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 uppermiddle-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/m2; 2.76 [2.52-3.03]). The relationship between diabetes prevalence and both BMI and family history ofdiabetes 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.

Original languageEnglish
Pages (from-to)780-787
Number of pages8
JournalDiabetes Care
Volume39
Issue number5
DOIs
Publication statusPublished - May 2016

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