title: The diabetes-obesity-hypertension nexus in Qatar: evidence from the World Health Survey.
abstract: BACKGROUND
  As countries develop economically, an "epidemiological transition" occurs whereby a set of chronic diseases increasingly becomes a country's health challenge. Against this background, this paper examines the most common conditions associated with the prevalence of diabetes in Qatar, with a specific focus on the diabetes-obesity-hypertension nexus.
  
  
  METHODS
  We analyzed data from the World Health Organization's World Health Survey conducted in the State of Qatar in 2006. The survey included demographic, anthropometric, and blood chemistry measurements. Using multivariate logistical regression analysis, we assessed the most common conditions associated with diabetes, using both objective and subjective measures of diabetes. The objective measures relied on random blood sugar tests, and the subjective measure included respondents who affirmatively answered the question on diabetes diagnosis. We repeated our analysis on respondents who had blood glucose levels high enough to be considered diabetic/glucose intolerant but did not answer affirmatively on the question of diabetes diagnosis.
  
  
  RESULTS
  WHEN USING THE OBJECTIVE MEASURE OF DIABETES, THE FOLLOWING CONDITIONS APPEARED SIGNIFICANT: obesity (OR = 1.5, 95% CI = 1.2 - 1.9), higher income (OR = 1.4, 95% CI = 1.0 - 1.9), high cholesterol (OR = 1.4, 95% CI = 1.0 - 1.9), having Qatari origin (OR = 1.3, 95% CI = 1.0 - 1.7), and increasing systolic blood pressure (SBP) 120-139 mmHg (OR = 1.5, 95% CI = 1.2 - 2.0), SBP 140-159 mmHg (OR = 2.2, 95% CI = 1.6 - 3.1), SBP > 160 mmHg (OR = 3.2, 95% CI = 2.0 - 5.3). Similar results were obtained using the subjective measure of diabetes as a dependent variable. When applied to the group of respondents that included pre-diabetics and those who did not know they were diabetic, obesity and hypertension appeared as the only statistically significant explanatory variables.
  
  
  CONCLUSIONS
  High prevalence of diabetes, hypertension, and especially obesity is documented among residents of Qatar. Further steps are required to tackle the most common conditions associated with the rising diabetes epidemic in the country, which might also pose significant fiscal challenges in the future.
authors.affiliation: Qatar Supreme Council of Health, Doha, Qatar.
authors.forename: Faleh Mohamed Hussain
authors.initials: FM
authors.lastname: Ali
authors.affiliation: London School of Economics, Houghton Street, WC2A 2AE London, UK.
authors.forename: Zlatko
authors.initials: Z
authors.lastname: Nikoloski
authors.affiliation: Qatar Supreme Council of Health, Doha, Qatar.
authors.forename: Husein
authors.initials: H
authors.lastname: Reka
authors.affiliation: Qatar Supreme Council of Health, Doha, Qatar.
authors.forename: Orsida
authors.initials: O
authors.lastname: Gjebrea
authors.affiliation: London School of Economics, Houghton Street, WC2A 2AE London, UK.
authors.forename: Elias
authors.initials: E
authors.lastname: Mossialos
keywords: Determinants of diabetes; Diabetes; Middle East; Obesity; Qatar