title: Economic and social impact of diabetes mellitus in a low-income country: A case-control study in Sudan.
abstract: BACKGROUND
  Diabetes mellitus accounts for 11% of total health expenditure worldwide, and most people with diabetes live in low- and middle-income countries. The present study examined the economic and social effects attributed to diabetes in Sudan by calculating out-of-pocket medical expenses and the health and social effects of the disease for people with diabetes (n = 375) and their families compared with a non-diabetic control group (n = 375), matched for age, sex, and residence area.
  
  
  METHODS
  Data were obtained in 2013 in four states within the Sudan, via structured interviews, using instruments from the International Diabetes Federation. Descriptive statistics were used to analyze differences between case and control participants.
  
  
  RESULTS
  The median total annual medical expenditure was fourfold higher for people with than without diabetes (US$579 vs US$148, respectively). Annual mean expenditure was 85% higher for those with diabetes (US$1004 vs US$544). People with diabetes were also significantly more likely to suffer from serious comorbidities, such as cardiovascular disorders and foot ulcers, compared with control participants. Moreover, those with diabetes reported a higher proportion of personal adverse social effects, such as being prevented from doing paid work or participating in education, both for themselves and their families.
  
  
  CONCLUSIONS
  The high economic burden and adverse social effects on people with diabetes and their families in Sudan call for the development of evidence-based policy and program strategies for the prevention and management of diabetes, with an emphasis on low-resource communities.
authors.affiliation: Department of Public Health Sciences, Global Health-Health System and Policy, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Hind A
authors.initials: HA
authors.lastname: Elrayah-Eliadarous
authors.affiliation: Endocrine and Diabetes Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Claes-Göran
authors.initials: CG
authors.lastname: Östenson
authors.affiliation: Department of Health Science, Mulazmin Diabetes Center, Ahfad University for Women, Omdurman, Sudan.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Eltom
authors.affiliation: Public Health and Economics, Huddinge, Sweden.
authors.forename: Pia
authors.initials: P
authors.lastname: Johansson
authors.affiliation: Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Vibeke
authors.identifier: http://orcid.org/0000-0002-1248-8600
authors.initials: V
authors.lastname: Sparring
authors.affiliation: Department of Public Health Sciences, Global Health-Health System and Policy, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Rolf
authors.initials: R
authors.lastname: Wahlström
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D017281:Cost of Illness; D003920:Diabetes Mellitus / Q000191:economics*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006306:Health Surveys / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000191:economics; D012922:Social Change; D013397:Sudan; D055815:Young Adult
keywords: Sudan; diabetes; health expenditure; low-income countries; social impact; 低收入国家; 医疗卫生支出; 社会影响; 糖尿病; 苏丹