Diabetes prevalence and its relationship with education, wealth, and body mass index in twenty-nine low- and middle-income countries

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 Msaidie, Corine Houehanou, Dismand Houinato, Jutta Mari Adelin JorgensenGibson 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 Davies, Sebastian Vollmer, Till W Bärnighausen, Lindsay M Jaacks, James B. Meigs , Deborah J. Wexler , Jennifer Manne-Goehler

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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 between education, household wealth, body mass index (BMI), and diabetes risk.

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, by country, World Bank Income Group (WBIG), and geographic region. Multivariable Poisson regression models were used to estimate relative risk (RR).

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: low-income (LICs) 6.7% (5.5% – 8.1%), lower-middle-income (LMIs) 7.1% (6.6% –7.6%), upper-middle-income countries (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, independent of BMI (LICs RR 1.47 [95% CI:1.22–1.78]; LMIs 1.14 [1.06–1.23]; UMIs 1.28 [1.02–1.61]).

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.

Original languageEnglish
JournalDiabetes Care
Publication statusAccepted/In press - 14 Jan 2020


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