title: Variations in Diabetes Prevalence in Low-, Middle-, and High-Income Countries: Results From the Prospective Urban and Rural Epidemiological Study.
abstract: The goal of this study was to assess whether diabetes prevalence varies by countries at different economic levels and whether this can be explained by known risk factors.
  
  
  
  The prevalence of diabetes, defined as self-reported or fasting glycemia ≥7 mmol/L, was documented in 119,666 adults from three high-income (HIC), seven upper-middle-income (UMIC), four lower-middle-income (LMIC), and four low-income (LIC) countries. Relationships between diabetes and its risk factors within these country groupings were assessed using multivariable analyses.
  
  
  
  Age- and sex-adjusted diabetes prevalences were highest in the poorer countries and lowest in the wealthiest countries (LIC 12.3%, UMIC 11.1%, LMIC 8.7%, and HIC 6.6%; P < 0.0001). In the overall population, diabetes risk was higher with a 5-year increase in age (odds ratio 1.29 [95% CI 1.28-1.31]), male sex (1.19 [1.13-1.25]), urban residency (1.24 [1.11-1.38]), low versus high education level (1.10 [1.02-1.19]), low versus high physical activity (1.28 [1.20-1.38]), family history of diabetes (3.15 [3.00-3.31]), higher waist-to-hip ratio (highest vs. lowest quartile; 3.63 [3.33-3.96]), and BMI (≥35 vs. <25 kg/m(2); 2.76 [2.52-3.03]). The relationship between diabetes prevalence and both BMI and family history of diabetes differed in higher- versus lower-income country groups (P for interaction < 0.0001). After adjustment for all risk factors and ethnicity, diabetes prevalences continued to show a gradient (LIC 14.0%, LMIC 10.1%, UMIC 10.9%, and HIC 5.6%).
  
  
  
  Conventional risk factors do not fully account for the higher prevalence of diabetes in LIC countries. These findings suggest that other factors are responsible for the higher prevalence of diabetes in LIC countries.
authors.affiliation: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, Canada gilles.dagenais@criucpq.ulaval.ca.
authors.forename: Gilles R
authors.initials: GR
authors.lastname: Dagenais
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.
authors.forename: Hertzel C
authors.initials: HC
authors.lastname: Gerstein
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.
authors.forename: Xiaohe
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: McQueen
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, and Healthy Heart Program, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Lear
authors.affiliation: Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia.
authors.forename: Patricio
authors.initials: P
authors.lastname: Lopez-Jaramillo
authors.affiliation: Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Mohan
authors.affiliation: Division of Epidemiology, Biostatistics and Population Health, St. John's Research Institute, Bangalore, India.
authors.forename: Prem
authors.initials: P
authors.lastname: Mony
authors.affiliation: Fortis Escorts Hospital, Malviya Nagar, Jaipur, India.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Health Action by People, Thiruvananthapuram, Kerala, India.
authors.forename: V Raman
authors.initials: VR
authors.lastname: Kutty
authors.affiliation: PGIMER School of Public Health, Chandigarh, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Independent University, Bangladesh, Bashundhara, Dhaka, Bangladesh.
authors.forename: Omar
authors.initials: O
authors.lastname: Rahman
authors.affiliation: Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia UCSI University, Cheras, Selangor, Malaysia.
authors.forename: Khalid
authors.initials: K
authors.lastname: Yusoff
authors.affiliation: Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Zatonska
authors.affiliation: Faculty of Medicine, Department of Internal Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
authors.forename: Aytekin
authors.initials: A
authors.lastname: Oguz
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital/Östra, Göteborg, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Rosengren
authors.affiliation: Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Roya
authors.initials: R
authors.lastname: Kelishadi
authors.affiliation: Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
authors.forename: Afzalhussein
authors.initials: A
authors.lastname: Yusufali
authors.affiliation: Estudios Clínicos Latinoamérica, Rosario, Argentina.
authors.forename: Rafael
authors.initials: R
authors.lastname: Diaz
authors.affiliation: Dante Pazzanese Institute of Cardiology, São Paulo, São Paulo, Brazil.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Avezum
authors.affiliation: Universidad de La Frontera, Temuco, Chile.
authors.forename: Fernando
authors.initials: F
authors.lastname: Lanas
authors.affiliation: Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
authors.forename: Annamarie
authors.initials: A
authors.lastname: Kruger
authors.affiliation: Non-communicable Diseases Research Unit, South African Medical Research Council, Durban, KwaZulu-Natal, South Africa Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa.
authors.forename: Nasheeta
authors.initials: N
authors.lastname: Peer
authors.affiliation: Physiology Department, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Jephat
authors.initials: J
authors.lastname: Chifamba
authors.affiliation: Departments of Community Health Sciences and Medicine, The Aga Khan University, Karachi, Pakistan.
authors.forename: Romaina
authors.initials: R
authors.lastname: Iqbal
authors.affiliation: Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Noorhassim
authors.initials: N
authors.lastname: Ismail
authors.affiliation: Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, FuWai Hospital, Beijing, China.
authors.forename: Bai
authors.initials: B
authors.lastname: Xiulin
authors.affiliation: Jianshe Road Community Health Center, Chengdu City, Sichuan Province, China.
authors.forename: Liu
authors.initials: L
authors.lastname: Jiankang
authors.affiliation: Health Center, Dayicaichang Town, Sichuan Province, China.
authors.forename: Deng
authors.initials: D
authors.lastname: Wenqing
authors.affiliation: Qiluhuayuan Hospital, Jinan City, Shandong Province, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Gejie
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.
authors.forename: Sumathy
authors.initials: S
authors.lastname: Rangarajan
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.
authors.forename: Koon
authors.initials: K
authors.lastname: Teo
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.
authors.forename: Salim
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mesh_terms: D000328:Adult; D000368:Aged; D019049:Developed Countries / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology*; D015444:Exercise; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*