title: Cross-country differences in the association between diabetes and disability.
abstract: OBJECTIVE
  This study tested possible cross-country differences in the associations between diabetes and activities of daily living (ADLs), and possible confounding / mediating effects of socio-economic status, obesity, and exercise.
  
  
  METHODS
  Data came from Research on Early Life and Aging Trends and Effects (RELATE). The study included a total number of 25,372 community sample of adults who were 40 years or older. We used data from community based surveys in seven countries including China, Mexico, Barbados, Brazil, Chile, Cuba, and Uruguay. Demographics (age and gender), socio-economic status (education and income), obesity, exercise, and ADL (bath, dress, toilet, transfer, heavy, shopping, meals) were measured. Self-reported data on physician diagnosis of diabetes was the independent variable. We tested if diabetes is associated with ADL, before and after adjusting for socio-economics, obesity, and exercise in each country.
  
  
  RESULTS
  Based on Model I (age and gender adjusted model), diabetes was associated with limitation in at least one ADL in Mexico, Barbados, Brazil, Chile, Cuba, and Uruguay, but not China. Based on Model II that also controlled for education and income, education explained the association between diabetes and limitation in ADL in Mexico and Uruguay. Based on Model III that also controlled for exercise and obesity, in Cuba and Brazil, exercise explained the link between diabetes and limitation in performing ADLs. Thus, the link between diabetes and ADL was independent of our covariates only in Chile and Barbados.
  
  
  CONCLUSIONS
  There are cross-country differences in the link between diabetes and limitation in ADL. There are also cross-country differences in how socio-economic status, obesity, and exercise explain the above association.
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA. assari@umich.edu.
authors.forename: Shervin
authors.initials: S
authors.lastname: Assari
authors.forename: Reza Moghani
authors.initials: RM
authors.lastname: Lankarani
authors.forename: Maryam Moghani
authors.initials: MM
authors.lastname: Lankarani