title: Cross-country variation in additive effects of socio-economics, health behaviors, and comorbidities on subjective health of patients with diabetes.
abstract: OBJECTIVE
  This study explored cross-country differences in the additive effects of socio-economic characteristics, health behaviors and medical comorbidities on subjective health of patients with diabetes.
  
  
  METHODS
  The study analyzed data from the Research on Early Life and Aging Trends and Effects (RELATE). The participants were 9,179 adults with diabetes who were sampled from 15 countries (i.e. China, Costa Rica, Puerto Rico, United States, Mexico, Argentina, Barbados, Brazil, Chile, Cuba, Uruguay, India, Ghana, South Africa, and Russia). We fitted three logistic regressions to each country. Model I only included socio-economic characteristics (i.e. age, gender, education and income). In Model II, we also included health behaviors (i.e. smoking, drinking, and exercise). Model III included medical comorbidities (i.e. hypertension, respiratory disease, heart disease, stroke, and arthritis), in addition to the previous blocks.
  
  
  RESULTS
  Our models suggested cross-country differences in the additive effects of socio-economic characteristics, health behaviors and comorbidities on perceived health of patients with diabetes. Comorbid heart disease was the only condition that was consistently associated with poor subjective health regardless of country.
  
  
  CONCLUSIONS
  Countries show different profiles of social and behavioral determinants of subjective health among patients with diabetes. Our study suggests that universal programs that assume that determinants of well-being are similar across different countries may be over-simplistic. Thus instead of universal programs that use one protocol for health promotion of patients in all countries, locally designed interventions should be implemented in each country.
authors.affiliation: Center for Research on Ethnicity, Culture, and Health (CRECH), Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, 2847-SPH I, Ann Arbor, MI 48109-2029, USA. assari@umich.edu.
authors.forename: Shervin
authors.initials: S
authors.lastname: Assari