title: The geography of diabetes among the general adults aged 35 years and older in Bangladesh: recent evidence from a cross-sectional survey.
abstract: OBJECTIVE
  To report geographical variations of sex-specific diabetes by place of residence (large cities/city corporations, small towns/other urban areas, rural areas) and region of residence (divided into seven divisions) among general adults (35+ years of age) in Bangladesh.
  
  
  METHODS
  The recent cross-sectional data, extracted from the nationally representative Bangladesh Demographic and Health Survey 2011, was used. A total of 3,720 men and 3,823 women aged 35+ years, who participated in the fasting blood sugar testing, were analysed. Any person with either fasting plasma glucose level (mmol/L) ≥7.0 or taking medication for diabetes was considered as a person with diabetes.
  
  
  RESULTS
  The prevalence of diabetes was 10.6% in men and 11.3% in women. Bivariable analyses indicated significant variations of diabetes by both geographical variables. The prevalence was highest in city corporations (men 18.0%, women 22.3%), followed by small towns (men 13.6%, women 15.2%) and rural areas (men 9.3%, women 9.5%). Regional disparities in diabetes prevalence were also remarkable, with the highest prevalence in Chittagong division and lowest prevalence in Khulna division. Multivariable logistic regression analyses provided mixed patterns of geographical disparities (depending on the adjusted variables). Some other independent risk factors for diabetes were advancing age, higher level of education and wealth, having TV (a proxy indicator of physical activity), overweight/obesity and hypertension.
  
  
  CONCLUSIONS
  Over 10% of the general adults aged 35 years and older were having diabetes. Most of the persons with diabetes were unaware of this before testing fasting plasma glucose level. Although significant disparities in diabetes prevalence by geographical variables were observed, such disparities are very much influenced by the adjusted variables. Finally, we underscore the necessities of area-specific strategies including early diagnosis and health education programmes for changing lifestyles to reduce the risk of diabetes in Bangladesh.
authors.affiliation: Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany.
authors.forename: Md Mobarak Hossain
authors.initials: MM
authors.lastname: Khan
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors.forename: Oliver
authors.initials: O
authors.lastname: Gruebner
authors.affiliation: Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kraemer
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors; D014505:Urban Population