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, Noor Hassim Ismail, Bai Xiulin, Liu Jiankang, Deng Wenqing, Yue Gejie, Sumathy Rangarajan, Koon Teo, Salim Yusuf

Research output: Contribution to journalArticle

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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. 2; 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 - 1 May 2016

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Epidemiologic Studies
Waist-Hip Ratio
Internship and Residency
Fasting
Research Design
Odds Ratio
Economics
Education

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing

Cite this

Dagenais, G. R., Gerstein, H. C., Zhang, X., McQueen, M., Lear, S., Lopez-Jaramillo, P., ... Yusuf, S. (2016). Variations in diabetes prevalence in low-, middle-, and high-income countries: Results from the prospective urban and rural epidemiological study. Diabetes Care, 39(5), 780-787. https://doi.org/10.2337/dc15-2338

Variations in diabetes prevalence in low-, middle-, and high-income countries : Results from the prospective urban and rural epidemiological study. / Dagenais, Gilles R.; Gerstein, Hertzel C.; Zhang, Xiaohe; McQueen, Matthew; Lear, Scott; Lopez-Jaramillo, Patricio; Mohan, Viswanathan; Mony, Prem; Gupta, Rajeev; Kutty, V. Raman; Kumar, Rajesh; Rahman, Omar; Yusoff, Khalid; Zatonska, Katarzyna; Oguz, Aytekin; Rosengren, Annika; Kelishadi, Roya; Yusufali, Afzalhussein; Diaz, Rafael; Avezum, Alvaro; Lanas, Fernando; Kruger, Annamarie; Peer, Nasheeta; Chifamba, Jephat; Iqbal, Romaina; Ismail, Noor Hassim; Xiulin, Bai; Jiankang, Liu; Wenqing, Deng; Gejie, Yue; Rangarajan, Sumathy; Teo, Koon; Yusuf, Salim.

In: Diabetes Care, Vol. 39, No. 5, 01.05.2016, p. 780-787.

Research output: Contribution to journalArticle

Dagenais, GR, Gerstein, HC, Zhang, X, McQueen, M, Lear, S, Lopez-Jaramillo, P, Mohan, V, Mony, P, Gupta, R, Kutty, VR, Kumar, R, Rahman, O, Yusoff, K, Zatonska, K, Oguz, A, Rosengren, A, Kelishadi, R, Yusufali, A, Diaz, R, Avezum, A, Lanas, F, Kruger, A, Peer, N, Chifamba, J, Iqbal, R, Ismail, NH, Xiulin, B, Jiankang, L, Wenqing, D, Gejie, Y, Rangarajan, S, Teo, K & Yusuf, S 2016, 'Variations in diabetes prevalence in low-, middle-, and high-income countries: Results from the prospective urban and rural epidemiological study', Diabetes Care, vol. 39, no. 5, pp. 780-787. https://doi.org/10.2337/dc15-2338
Dagenais, Gilles R. ; Gerstein, Hertzel C. ; Zhang, Xiaohe ; McQueen, Matthew ; Lear, Scott ; Lopez-Jaramillo, Patricio ; Mohan, Viswanathan ; Mony, Prem ; Gupta, Rajeev ; Kutty, V. Raman ; Kumar, Rajesh ; Rahman, Omar ; Yusoff, Khalid ; Zatonska, Katarzyna ; Oguz, Aytekin ; Rosengren, Annika ; Kelishadi, Roya ; Yusufali, Afzalhussein ; Diaz, Rafael ; Avezum, Alvaro ; Lanas, Fernando ; Kruger, Annamarie ; Peer, Nasheeta ; Chifamba, Jephat ; Iqbal, Romaina ; Ismail, Noor Hassim ; Xiulin, Bai ; Jiankang, Liu ; Wenqing, Deng ; Gejie, Yue ; Rangarajan, Sumathy ; Teo, Koon ; Yusuf, Salim. / Variations in diabetes prevalence in low-, middle-, and high-income countries : Results from the prospective urban and rural epidemiological study. In: Diabetes Care. 2016 ; Vol. 39, No. 5. pp. 780-787.
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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. 2; 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.",
author = "Dagenais, {Gilles R.} and Gerstein, {Hertzel C.} and Xiaohe Zhang and Matthew McQueen and Scott Lear and Patricio Lopez-Jaramillo and Viswanathan Mohan and Prem Mony and Rajeev Gupta and Kutty, {V. Raman} and Rajesh Kumar and Omar Rahman and Khalid Yusoff and Katarzyna Zatonska and Aytekin Oguz and Annika Rosengren and Roya Kelishadi and Afzalhussein Yusufali and Rafael Diaz and Alvaro Avezum and Fernando Lanas and Annamarie Kruger and Nasheeta Peer and Jephat Chifamba and Romaina Iqbal and Ismail, {Noor Hassim} and Bai Xiulin and Liu Jiankang and Deng Wenqing and Yue Gejie and Sumathy Rangarajan and Koon Teo and Salim Yusuf",
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T1 - Variations in diabetes prevalence in low-, middle-, and high-income countries

T2 - Results from the prospective urban and rural epidemiological study

AU - Dagenais, Gilles R.

AU - Gerstein, Hertzel C.

AU - Zhang, Xiaohe

AU - McQueen, Matthew

AU - Lear, Scott

AU - Lopez-Jaramillo, Patricio

AU - Mohan, Viswanathan

AU - Mony, Prem

AU - Gupta, Rajeev

AU - Kutty, V. Raman

AU - Kumar, Rajesh

AU - Rahman, Omar

AU - Yusoff, Khalid

AU - Zatonska, Katarzyna

AU - Oguz, Aytekin

AU - Rosengren, Annika

AU - Kelishadi, Roya

AU - Yusufali, Afzalhussein

AU - Diaz, Rafael

AU - Avezum, Alvaro

AU - Lanas, Fernando

AU - Kruger, Annamarie

AU - Peer, Nasheeta

AU - Chifamba, Jephat

AU - Iqbal, Romaina

AU - Ismail, Noor Hassim

AU - Xiulin, Bai

AU - Jiankang, Liu

AU - Wenqing, Deng

AU - Gejie, Yue

AU - Rangarajan, Sumathy

AU - Teo, Koon

AU - Yusuf, Salim

PY - 2016/5/1

Y1 - 2016/5/1

N2 - 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. 2; 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.

AB - 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. 2; 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.

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