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Shahrestanaki E, Mohammadian Khonsari N, Seif E, Baygi F, Ejtahed HS, Sheidaei A, Djalalinia S, Magliano DJ, Qorbani M. The worldwide trend in diabetes awareness, treatment, and control from 1985 to 2022: a systematic review and meta-analysis of 233 population-representative studies. Front Public Health 2024; 12:1305304. [PMID: 38827607 PMCID: PMC11140097 DOI: 10.3389/fpubh.2024.1305304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 03/06/2024] [Indexed: 06/04/2024] Open
Abstract
Background With the rapid increase in the prevalence of DM, studies on the awareness, treatment, and control of this condition are essential. Therefore, this study aimed to review the literature and pool the awareness, treatment, and control of diabetes at the global, regional, and national levels. Methods In this systematic review and meta-analysis, several databases, including MEDLINE/PubMed, Institute of Scientific Information (ISI), Scopus, and Google Scholar, were searched using appropriate keywords up to June 2022. Observational studies investigating the awareness, treatment, and control of glucose levels among diabetic individuals were included. Awareness, treatment, and control were defined as the proportion of participants who were aware of their diabetes condition, treated pharmacologically, and achieved adequate glucose control, respectively. Two investigators independently conducted the study selection, data extraction, and quality assessment. Heterogeneity among studies was calculated using Chi-square, and a random-effect meta-analysis was used to pool the rates. Results A total of 233 studies published between 1985 and 2022 met the inclusion criteria. The included studies had a combined population of 12,537,968. The pooled awareness of DM was 60% (95%CI: 56-63) and ranged from 41% (25-57) in low-income countries to 68% (64-72) in high-income countries, with no significant trend observed over the assessed periods at the global level. The pooled treatment of DM globally was 45% (42-48) and varied from 37% (31-43) in lower-middle-income countries to 53% (47-59) in high-income countries, showing variation over the examined time period. Before 2000, the proportion of adequate DM control was 16% (12-20), which significantly improved and reached 22% (19-25) after 2010. The pooled awareness, treatment, and control of DM were higher in females, high-income countries, and urban areas compared to males, upper and lower-middle-income countries, and rural areas, respectively. The older adults population had higher awareness and treatment rates than the adult population, but their DM control did not differ significantly. Conclusion Despite the high level of awareness and treatment among the diabetic population, treatment success (control) is considerably low, particularly in low-income countries and rural areas. It is crucial to improve awareness, treatment, and control by strengthening the primary care system in all countries.
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Affiliation(s)
- Ehsan Shahrestanaki
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ehsan Seif
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Fereshteh Baygi
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Hanieh-Sadat Ejtahed
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Deputy of Research & Technology, Ministry of Health & Medical Education, Tehran, Iran
| | - Dianna J. Magliano
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Khatun MM, Rahman M, Islam MJ, Haque SE, Adam IF, Chau Duc NH, Sarkar P, Haque MN, Islam MR. Socio-economic inequalities in undiagnosed, untreated, and uncontrolled diabetes mellitus in Bangladesh: is there a gender difference? Public Health 2023; 218:1-11. [PMID: 36933353 DOI: 10.1016/j.puhe.2023.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/13/2022] [Accepted: 01/31/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES We aimed to determine: (1) the prevalence and socio-economic distribution of undiagnosed, untreated, and uncontrolled diabetes mellitus (DM); (2) the relationship between socio-economic status (SES) and undiagnosed, untreated, and uncontrolled DM; and (3) if this relationship is mediated by gender. STUDY DESIGN Cross-sectional nationally representative household-based survey. METHODS We used data from the Bangladesh Demographic Health Survey from 2017 to 18. Our findings were based on the responses of 12,144 individuals aged 18 years and older. As a measure of SES, we focused on standard of living (hereinafter referred to as wealth). The study's outcome variables were prevalence of total (diagnosed + undiagnosed), undiagnosed, untreated, and uncontrolled DM. We used three regression-based approaches-adjusted odds ratio, relative inequality index, and slope inequality index-to assess different aspects of SES differences in the prevalence of total, undiagnosed, untreated, and uncontrolled DM. We used logistic regression analysis to look at the adjusted association between SES and the outcomes after gender stratification to see whether gender status moderates the association between SES and the targeted outcomes. RESULTS In our sample analysis, the age-adjusted prevalence of total, undiagnosed, untreated, and uncontrolled DM was 9.1%, 61.4%, 64.7%, and 72.1%, respectively. Females had a higher prevalence of DM and undiagnosed, untreated, and uncontrolled DM than males. When compared to people in the poor SES group, people in the rich and middle SES groups had 2.60 times (95% confidence interval [CI] 2.05-3.29) and 1.47 times (95% CI 1.18-1.83) higher chance of developing DM. When compared to individuals in the poor SES group, those in the rich SES groups were 0.50 (95% CI 0.33-0.77) and 0.55 times (95% CI 0.36-0.85) less likely to have undiagnosed and untreated DM. CONCLUSIONS In Bangladesh, rich SES groups were more likely than poor SES groups to have DM, whereas poor SES groups with DM were less likely than rich SES groups to be aware of their disease and obtain treatment. The government and other concerned parties are urged by this study to pay more attention to developing suitable policy measures to reduce the risk of DM, particularly among rich SES groups, as well as targeted efforts to screen for and diagnose DM in socio-economically disadvantaged groups.
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Affiliation(s)
- M M Khatun
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi 6205, Bangladesh
| | - M Rahman
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi 6205, Bangladesh.
| | - M J Islam
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD 4122, Australia
| | - S E Haque
- Uchicago Research Bangladesh, Bangladesh
| | - I F Adam
- Faculty of Public Health, University of Khartoum, Sudan
| | - N H Chau Duc
- Hue University of Medicine and Pharmacy, Hue University, Viet nam
| | - P Sarkar
- Dr. Wazed Research and Training Institute, Begum Rokeya University, Rangpur, Bangladesh
| | - M N Haque
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi 6205, Bangladesh
| | - M R Islam
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi 6205, Bangladesh
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Prevalence of prediabetes, diabetes, diabetes awareness, treatment, and its socioeconomic inequality in west of Iran. Sci Rep 2022; 12:17892. [PMID: 36284227 PMCID: PMC9596718 DOI: 10.1038/s41598-022-22779-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/19/2022] [Indexed: 01/20/2023] Open
Abstract
We aim to estimate the prevalence of prediabetes, and diabetes mellitus (DM). We estimated awareness, treatment, plasma glucose control, and associated factors in diabetes, as well as, socioeconomic-related inequality in the prevalence of diabetes and prediabetes. Data for adults aged 35-70 years were obtained from the baseline phase of the Dehgolan prospective cohort study (DehPCS). Diabetes status was determined as fasting plasma glucose (FPG) of ≥ 126 mg/dl and/or taking glucose lowering medication confirmed by a medical practitioner. Prediabetes was considered as 100 ≤ FPG ≤ 125 mg/dl. The relative concentration index (RCI) was used to exhibit socioeconomic inequality in the prevalence of prediabetes and DM. Prevalence of prediabetes and DM, diabetes awareness and treatment, and glycemic control of DM 18.22%, 10.00%, 78.50%, 68.91% and, 28.50%, respectively. Increasing age (p < 0.001), Increasing body mass index (BMI) (p < 0.05), ex-smoker (p < 0.01), family history of diabetes (FHD) (p < 0.001), and comorbidity (p < 0.001) were independent risk factors for DM. Age group of 46-60 (p < 0.05), ex-smoker (p < 0.05), FHD (p < 0.05) were increased chance of awareness. Current smokers (p < 0.05), and higher education increase the chance of glycemic control in DM. Both DM (RCI = - 0.234) and prediabetes (RCI = - 0.122) were concentrated significantly among less-educated participants. DM was concentrated significantly among poor (RCI = - 0.094) people. A significant proportion of DM awareness and treatment can be due to the integration of diabetes into the primary health care system. The high prevalence of prediabetes and diabetes, which is affected by socioeconomic inequality and combined with low levels of glycemic control may place a greater burden on the health system. Therefore, awareness, receiving treatment, and glycemic control in people with diabetes, and the socioeconomic status of people have become increasingly important in the near future.
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Hu H, Xu Y, Shao Y, Liang Y, Wang Q, Luo S, Lu H, Meng H, Liu C. A latent profile analysis of residents' knowledge, attitude, and practice toward common chronic diseases among ethnic minority area in China. Front Public Health 2022; 10:940619. [PMID: 35958853 PMCID: PMC9357989 DOI: 10.3389/fpubh.2022.940619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHealth literacy plays an important role in preventing and managing chronic diseases, while low levels of health literacy among ethnic minorities are a major manifestation of health inequities. We believe that before effective health literacy intervention strategies, it is preferable to understand the features of health literacy among ethnic minorities. The present study firstly updated insights on health literacy among ethnic minorities by investigating the knowledge, attitude, and practice (KAP) profile of common chronic diseases in ethnic minority areas, and secondly discussed the KAP profiles in detail to inspire future health education interventions.MethodsA cross-sectional, health-literacy-sensitive study was conducted in China's typical ethnic minority area. Participants included 801 adult residents who lived in the ethnic minority area. The primary outcome was participant scores on the KAP questionnaire of common chronic diseases, followed by latent profile analysis to identify participants with similar KAP score patterns and determine whether membership in specific groups was associated with demographic or clinical characteristics.ResultsThe participants included 496 ethnic minorities (61.9%) and 305 Han Chinese (38.1%). Three-profile solution was determined after the latent profile analysis: incomplete transfer [I.T.] (n = 215), better practice [B.P.] (n = 301), and average [A.V.] (n = 285). IT group (26.84%) was characterized by the highest level of knowledge and attitude toward common chronic diseases and below average level for practice. Participants in B.P. group performed poorly in both knowledge and attitude toward common chronic diseases but had the highest level of practice. A.V. group reflected average knowledge, attitude, and practice toward common chronic diseases among three subgroups. Ethnic minorities were the dominant population in A.V. group (68.8%). Compared with other groups, the A.V. group contained the largest proportions of married participants (84.2%), participants with no formal education (46.7%), and high annual out-of-pocket medical expense (33.3%).ConclusionA more specific and nuanced understanding of minority health literacy can enable service providers to provide more effective health education to their recipients, thereby improving health inequities.
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Affiliation(s)
- Huaqin Hu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yihua Xu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Yihua Xu
| | - Yingshan Shao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaxin Liang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Shunmei Luo
- Lincang Second People's Hospital, Lincang, China
| | - Heyun Lu
- Lincang Second People's Hospital, Lincang, China
| | - Heng Meng
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Chenxi Liu
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Jang HN, Moon MK, Koo BK. Prevalence of Diabetic Retinopathy in Undiagnosed Diabetic Patients: A Nationwide Population-Based Study. Diabetes Metab J 2022; 46:620-629. [PMID: 35193173 PMCID: PMC9353559 DOI: 10.4093/dmj.2021.0099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/29/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We investigated the prevalence of diabetic retinopathy (DR) in patients with undiagnosed diabetes through a nationwide survey, compared to those with known diabetes. METHODS Among the participants of the Korean National Health and Nutrition Examination Surveys (KNHANES) from 2017 to 2018, individuals aged ≥40 years with diabetes and fundus exam results were enrolled. Sampling weights were applied to represent the entire Korean population. Newly detected diabetes patients through KNHANES were classified under "undiagnosed diabetes." RESULTS Among a total of 9,108 participants aged ≥40 years, 951 were selected for analysis. Of them, 31.3% (standard error, ±2.0%) were classified under "undiagnosed diabetes." The prevalence of DR in patients with known and undiagnosed diabetes was 24.5%±2.0% and 10.7%±2.2%, respectively (P<0.001). The DR prevalence increased with rising glycosylated hemoglobin (HbA1c) levels in patients with known and undiagnosed diabetes (P for trend=0.001 in both). Among those with undiagnosed diabetes, the prevalence of DR was 6.9%±2.1%, 8.0%±3.4%, 5.6%±5.7%, 16.7%±9.4%, and 42.6%±14.8% for HbA1c levels of <7.0%, 7.0%-7.9%, 8.0%-8.9%, 9.0%-9.9%, and ≥10.0% respectively. There was no difference in the prevalence of hypertension, dyslipidemia, hypertriglyceridemia, or obesity according to the presence or absence of DR. CONCLUSION About one-third of patients with diabetes were unaware of their diabetes, and 10% of them have already developed DR. Considering increasing the prevalence of DR according to HbA1c level was found in patients with undiagnosed diabetes like those with known diabetes, screening and early detection of diabetes and DR are important.
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Affiliation(s)
- Han Na Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Bo Kyung Koo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- Corresponding author: Bo Kyung Koo https://orcid.org/0000-0002-6489-2656 Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea E-mail:
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The Effect of Neighborhood Deprivation on Mortality in Newly Diagnosed Diabetes Patients: A Countrywide Population-Based Korean Retrospective Cohort Study, 2002-2013. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074324. [PMID: 35410005 PMCID: PMC8998590 DOI: 10.3390/ijerph19074324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/17/2022]
Abstract
Background: Neighborhood environmental factors along with individual factors are beginning to make a mark as factors which influence individual health outcomes. The goal of this study is to look at the combined impact of individual and neighborhood socioeconomic status on all-cause mortality in diabetic patients who have just been diagnosed. Methods: The Korean National Health Insurance (2002–2013) was employed in this cohort research, which used a stratified random sample. During the years 2003–2006, a total of 15,882 individuals who were newly diagnosed with diabetes and using oral disease-controlling medication were included in the study. Individual income and neighborhood deprivation index were used to examine the combined effect on all-cause mortality. The frailty model was performed using Cox’s proportional hazard regression. Results: During the study period, 28.3 percent (n = 4493) of the 15,882 eligible individuals died. In a Cox regression analysis after adjusting for all covariates, with advantaged and disadvantaged neighborhoods classified according to individual household income, the adjusted HR for patients living in a disadvantaged area was higher compared to patients living in an advantaged area in patients with middle income, compared to the reference group (a high income within an advantaged neighborhood) (HR, 1.22; 95% CI, 1.09–1.35; HR, 1.13; 95% CI, 1.02–1.25, respectively). The adjusted HR for patients with low income who lived in a disadvantaged location was greater than for patients who lived in an advantaged area (HR, 1.34; 95% CI, 1.18–1.53 vs. HR, 1.28; 95% CI, 1.14–1.49). Conclusions: Individual SES has a greater impact on all-cause mortality among diabetic patients when they live in a low-income neighborhood.
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Wen C, Huang X, Feng L, Chen L, Hu W, Lai Y, Hao Y. High-resolution age-specific mapping of the two-week illness prevalence rate based on the National Health Services Survey and geostatistical analysis: a case study in Guangdong province, China. Int J Health Geogr 2021; 20:20. [PMID: 33941201 PMCID: PMC8094611 DOI: 10.1186/s12942-021-00273-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/23/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The two-week illness prevalence rate is an important and comparable indicator of health service needs. High-spatial-resolution, age-specific risk mapping of this indicator can provide valuable information for health resource allocation. The age-prevalence relationships may be different among areas of the study region, but previous geostatistical models usually ignored the spatial-age interaction. METHODS We took Guangdong province, the province with the largest population and economy in China, as a study case. We collected two-week illness data and other potential influencing predictors from the fifth National Health Services Survey in 2013 and other open-access databases. Bayesian geostatistical binary regression models were developed with spatial-age structured random effect, based on which, high-resolution, age-specific two-week illness prevalence rates, as well as number of people reporting two-week illness, were estimated. The equality of health resource distribution was further evaluated based on the two-week illness mapping results and the health supply data. RESULTS The map across all age groups revealed that the highest risk was concentrated in the central (i.e., Pearl River Delta) and northern regions of the province. These areas had a two-week illness prevalence > 25.0%, compared with 10.0-20.0% in other areas. Age-specific maps revealed significant differences in prevalence between age groups, and the age-prevalence relationships also differed across locations. In most areas, the prevalence rates decrease from age 0 to age 20, and then increase gradually. Overall, the estimated age- and population-adjusted prevalence was 16.5% [95% Bayesian credible interval (BCI): 14.5-18.6%], and the estimated total number of people reporting illness within the two-week period was 17.5 million (95% BCI: 15.5-19.8 million) in Guangdong Province. The Lorenz curve and the Gini coefficient (resulted in 0.3526) showed a moderate level of inequality in health resource distribution. CONCLUSIONS We developed a Bayesian geostatistical modeling framework with spatial-age structured effect to produce age-specific, high-resolution maps of the two-week illness prevalence rate and the numbers of people reporting two-week illness in Guangdong province. The methodology developed in this study can be generalized to other global regions with available relevant survey data. The mapping results will support plans for health resource allocation.
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Affiliation(s)
- Chuchun Wen
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xiaoliang Huang
- Department of Statistics, Government Affairs Service Center of Health Commission of Guangdong Province, Guangzhou, 510060, China
| | - Lifen Feng
- Department of Statistics, Government Affairs Service Center of Health Commission of Guangdong Province, Guangzhou, 510060, China
| | - Long Chen
- Department of Statistics, Government Affairs Service Center of Health Commission of Guangdong Province, Guangzhou, 510060, China
| | - Wei Hu
- Department of Statistics, Government Affairs Service Center of Health Commission of Guangdong Province, Guangzhou, 510060, China
| | - Yingsi Lai
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Yuantao Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
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A cross-sectional study on diabetes epidemiology among people aged 40 years and above in Shenyang, China. Sci Rep 2020; 10:17742. [PMID: 33082483 PMCID: PMC7576584 DOI: 10.1038/s41598-020-74889-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/06/2020] [Indexed: 12/15/2022] Open
Abstract
This study aimed at understanding the diabetic prevalence, awareness, treatment and control rates and their influencing factors among people aged ≥ 40 years in Shenyang, China. A face-to-face cross-sectional epidemiological survey was conducted on the respondents using the national unified questionnaire. A total of 3922 respondents were enrolled, including 609 cases of diabetes. The diabetic prevalence rate was 15.5%, and was higher in rural areas than that in urban areas (17.7% vs. 14.2%, p = 0.004), while no difference was observed between men and women (14.8% vs. 16.1%, p = 0.242). Advanced age, hypertension and dyslipidemia were the diabetes influencing factors. Among the 609 respondents with diabetes, the diabetic awareness and treatment rates, and the control rate of fasting plasma glucose were 82.3%, 36.6% and 17.1%, respectively. In different age groups, the diabetic awareness rate was higher in men than that in women, and the treatment rate was higher in women than that in men. The diabetic patients, who consumed fruit for ≥ 5 days a week, accounted for 16.3%, and their diabetic treatment (28.1%) and control rates (44.1%) were lower. Shenyang people aged ≥ 40 years have higher diabetic prevalence and awareness rates, and lower diabetic treatment and control rates. Finally, it is necessary to enhance awareness and education about diabetes, to improve its treatment and control rates.
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Kimura Y, Yoshida D, Hirakawa Y, Hata J, Honda T, Shibata M, Sakata S, Uchida K, Kitazono T, Ninomiya T. Dietary fiber intake and risk of type 2 diabetes in a general Japanese population: The Hisayama Study. J Diabetes Investig 2020; 12:527-536. [PMID: 32738819 PMCID: PMC8015811 DOI: 10.1111/jdi.13377] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/11/2020] [Accepted: 07/23/2020] [Indexed: 12/25/2022] Open
Abstract
Aims/Introduction The investigation of the influence of dietary fiber intake on the incidence of type 2 diabetes in a general Japanese population. Materials and Methods A total of 1,892 individuals aged 40–79 years without diabetes at baseline were prospectively followed up for 14 years. The glucose tolerance status of participants was defined by a 75‐g oral glucose tolerance test with the 1998 World Health Organization criteria. Dietary fiber intake was estimated by a semiquantitative food frequency questionnaire and divided to quintile levels separately by sex. A Cox proportional hazards model was applied for computing the hazard ratios and their 95% confidence intervals for the incidence of diabetes. Results During the follow‐up period, 280 participants had developed diabetes. The age‐adjusted cumulative diabetes incidence decreased significantly with higher total dietary fiber intake (P‐for trend = 0.01). Participants in the highest quintile of total dietary fiber intake had a 0.53‐fold (95% confidence interval 0.31–0.90) lower risk of developing diabetes than those in the lowest quintile after for the adjustment with potential confounding factors. Total dietary fiber intake showed a moderate positive correlation to the intake of soybean and soybean products, green vegetables, and other vegetables. Similar associations with diabetes and food sources were observed for both of the soluble and insoluble dietary fiber intake. Conclusions The present study showed that higher dietary fiber intake was associated with a lower risk of type 2 diabetes in a general Japanese population. The intake of high dietary fiber foods might be useful for diabetes prevention.
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Affiliation(s)
- Yasumi Kimura
- Department of Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daigo Yoshida
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoichiro Hirakawa
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun Hata
- Department of Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanori Honda
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mao Shibata
- Department of Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoko Sakata
- Department of Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuhiro Uchida
- Department of Nutritional Sciences, Nakamura Gakuen University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Cai L, Li X, Cui W, You D, Golden AR. Trends in diabetes and pre-diabetes prevalence and diabetes awareness, treatment and control across socioeconomic gradients in rural southwest China. J Public Health (Oxf) 2019; 40:375-380. [PMID: 28977385 DOI: 10.1093/pubmed/fdx097] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 07/12/2017] [Indexed: 01/06/2023] Open
Abstract
Background This study aimed to determine trends in pre-diabetes and diabetes prevalence and diabetes awareness, treatment and control across socioeconomic gradients in rural southwest China. Methods Data were collected from two cross-sectional health interviews and examination surveys among individuals aged ≥35 years in rural China. Fasting blood sugar levels were measured for each participant. Results From 2009 to 2016, the overall prevalence of pre-diabetes and diabetes increased from 8.4 and 7.7% to 19.0 and 9.5%, respectively, while awareness, treatment and control of diabetes increased from 32.7, 20.0 and 6.1% to 49.3, 32.1 and 13.5%, respectively (P < 0.01). Participants with higher annual incomes had higher diabetes prevalence and treatment levels than their counterparts and showed a remarkably high increase in rate of pre-diabetes (P < 0.01). Whereas prevalence of pre-diabetes and diabetes increased across all ethnic groups during the study period, increased rates of diabetes awareness, treatment and control were only observed among Han Chinese (P < 0.01). Diabetic patients with higher levels of education had higher awareness, control and treatment of diabetes than their counterparts (P < 0.05). Conclusions The prevalence of pre-diabetes and diabetes and the level of diabetes awareness, treatment and control increased substantially across all socioeconomic gradients in rural southwest China.
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Affiliation(s)
- Le Cai
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, Kunming, China
| | - Xiao Li
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, Kunming, China
| | - Wenlong Cui
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, Kunming, China
| | - Dingyun You
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, Kunming, China
| | - Allison Rabkin Golden
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, Kunming, China
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11
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Li J, Ni J, Wu Y, Zhang H, Liu J, Tu J, Cui J, Ning X, Wang J. Sex Differences in the Prevalence, Awareness, Treatment, and Control of Diabetes Mellitus Among Adults Aged 45 Years and Older in Rural Areas of Northern China: A Cross-Sectional, Population-Based Study. Front Endocrinol (Lausanne) 2019; 10:147. [PMID: 30923514 PMCID: PMC6426742 DOI: 10.3389/fendo.2019.00147] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/19/2019] [Indexed: 01/03/2023] Open
Abstract
Aims: Diabetes mellitus (DM) has reached epidemic proportions among adults worldwide, with China having the world's largest population of individuals with the disease. Although the consequences of low rates of awareness, treatment, and control of DM are understood, sex-related differences in these rates remain unknown. We assessed sex-related differences in the prevalence, awareness, treatment, and control of DM in a low-income, rural population in China. Materials and Methods: Individuals ≥45 years old without cardiovascular disease were recruited into this study. The prevalence, awareness, treatment, and control of DM in both men and women were assessed after accounting for age, educational level, body mass index, and blood pressure. Results: A total of 3,725 participants (women, 58.8%) were included. A male preponderance in the prevalence of DM was found among individuals aged 45-54 years, whereas there was a female preponderance among patients aged 65-74 years and among those who were illiterate. Among individuals with >6 years of formal education, overweight individuals, and normotensive individuals, there was greater DM awareness among women than among men. There was also a higher DM treatment rate among overweight women than among overweight men. However, better disease control was observed among men than among women for individuals aged 55-64-years, those with 1-6 years of education, and those with stage II hypertension. Conclusions: These results suggest that DM awareness should be improved among men and that regular DM screening should be implemented for men, especially young men. In addition, disease education and management should be strengthened for elderly women, especially those with low levels of education. Further studies are necessary to explore this situation among a representative population sample in China in order to establish a valid protocol against DM.
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Affiliation(s)
- Jingyan Li
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Jingxian Ni
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Epidemiology, Tianjin Neurological Institute, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin, China
| | - Yanan Wu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Epidemiology, Tianjin Neurological Institute, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin, China
| | - Hongyan Zhang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Jie Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Epidemiology, Tianjin Neurological Institute, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin, China
| | - Jun Tu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Epidemiology, Tianjin Neurological Institute, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin, China
| | - Jingqiu Cui
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
- *Correspondence: Jingqiu Cui
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Epidemiology, Tianjin Neurological Institute, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin, China
- Xianjia Ning
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Epidemiology, Tianjin Neurological Institute, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin, China
- Jinghua Wang
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12
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Ogunsina K, Dibaba DT, Akinyemiju T. Association between life-course socio-economic status and prevalence of cardio-metabolic risk ractors in five middle-income countries. J Glob Health 2018; 8:020405. [PMID: 30023052 PMCID: PMC6036943 DOI: 10.7189/jogh.08.020405] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The burden of non-communicable diseases has increased rapidly in low- and middle-income countries. Past studies have reported an association between socioeconomic status (SES) and cardio-metabolic risk factors, but most have focused on upper income countries. The purpose of this study is to examine the association between SES over the life-course and the burden of cardio-metabolic risk factors in middle-income countries. METHODS A total of 38 297 adults from China, Mexico, India, South Africa and Russia were included in this cross-sectional study. Life-course SES was defined based on maternal and participant education, and data on blood pressure, body mass index (BMI), self-reported diabetes and hypertension were obtained by trained interviewers. Descriptive, age standardized and multivariable adjusted analyses were conducted using survey weighted statistical procedures in SAS 9.4 (SAS Institute, Cary, NC, USA). RESULTS Although 14% of men and 12% of women had current hypertension based on blood pressure measurements, only 2% of men and 4% of women were aware of their hypertensive status. Men with stable high life-course SES had higher odds of being overweight/obese (odds ratio OR = 2.01, 95% confidence interval (CI) = 1.30-3.10), diabetic (OR = 4.82, 95% CI = 2.07-11.2) and hypertensive based on self-report (OR = 3.42, 95% CI = 1.85-6.32) compared to men of low life-course SES. Among women, the odds of being overweight/obese were significantly higher among women with high life-course SES (OR = 1.50, 95% CI = 1.08-2.08). CONCLUSIONS Higher life-course SES for both men and women was associated with increased odds of overweight/ obesity, and additionally diabetes and hypertension for men in middle income countries.
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Affiliation(s)
- Kemi Ogunsina
- Department of Epidemiology, University of Miami, Miami, Florida, USA
| | - Daniel T Dibaba
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky,USA
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Tomi Akinyemiju
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky,USA
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
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13
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Wu H, Jackson CA, Wild SH, Jian W, Dong J, Gasevic D. Socioeconomic status and self-reported, screen-detected and total diabetes prevalence in Chinese men and women in 2011-2012: a nationwide cross-sectional study. J Glob Health 2018; 8:020501. [PMID: 30140436 PMCID: PMC6076585 DOI: 10.7189/jogh.08.020501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background A rapid epidemiological transition is taking place in China and the association between socioeconomic status (SES) and diabetes prevalence is not clear and may vary by population characteristics and geography within the country. We describe the associations between educational level, annual household living expenditure (AHLE) and diabetes prevalence in a large middle-aged and elderly Chinese population using data from a nationwide cross-sectional study. Methods We used data from the China Health and Retirement Longitudinal Study, which collected information from interviews and blood tests from a nationwide sample of people over 44 years of age in 2011-2012. We used multivariable logistic regression to describe the association between highest levels of education (high school or above compared to illiterate) or AHLE (top vs bottom quartile) and self-reported, screen-detected or total diabetes prevalence. We stratified by sex and adjusted for age, education or AHLE (as appropriate), urban, rural or migrant residence status and geographical area. Results Complete data were available for 10 100 participants of whom 10.5% and 28.9% had the highest and the lowest levels of education respectively. Overall prevalence of self-reported diabetes was 6.0% and of screen-detected diabetes was 9.8%. Higher education level was associated with both self-reported diabetes (odds ratio (OR) = 2.41, 95% confidence interval CI = 1.36-4.46) and total diabetes (OR = 1.53 95%, CI = 1.10-2.15) only in men. AHLE was associated with self-reported diabetes in men (OR = 1.87, 95% CI = 1.26-2.84) and women (OR = 2.31, 95% CI = 1.62-3.34). There was no association between SES and screen-detected diabetes for men or women. Conclusions SES inequalities exist in prevalence of diabetes in China and can be used to inform approaches to prevention. Identification and appropriate intervention for people with undiagnosed diabetes is required for all SES groups.
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Affiliation(s)
- Hongjiang Wu
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Caroline A Jackson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Weiyan Jian
- School of Public Health, Peking University, Beijing, China
| | - Jianqun Dong
- National Centre for Chronic and Noncommunicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Danijela Gasevic
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
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14
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Rockers PC, Laing RO, Wirtz VJ. Equity in access to non-communicable disease medicines: a cross-sectional study in Kenya. BMJ Glob Health 2018; 3:e000828. [PMID: 29989082 PMCID: PMC6035514 DOI: 10.1136/bmjgh-2018-000828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/24/2018] [Accepted: 05/26/2018] [Indexed: 01/12/2023] Open
Abstract
Introduction Wealth-based inequity in access to medicines is an impediment to achieving universal health coverage in many low-income and middle-income countries. We explored the relationship between household wealth and access to medicines for non-communicable diseases (NCDs) in Kenya. Methods We administered a cross-sectional survey to a sample of patients prescribed medicines for hypertension, diabetes or asthma. Data were collected on medicines available in the home, including the location and cost of purchase. Household asset information was used to construct an indicator of wealth. We analysed the relationship between household wealth and various aspects of access, including the probability of having NCD medicines at home and price paid. Results Among 639 patients interviewed, hypertension was the most prevalent NCD (69.6%), followed by diabetes (22.2%) and asthma (20.2%). There was a positive and statistically significant association between wealth and having medicines for patients with hypertension (p=0.020) and asthma (p=0.016), but not for diabetes (p=0.160). Poorer patients lived farther from their nearest health facility (p=0.050). There was no relationship between household wealth and the probability that the nearest public or non-profit health facility had key NCD medicines in stock, though less poor patients were significantly more likely to purchase medicines at better stocked private outlets. The relationship between wealth and median price paid for metformin by patients with diabetes was strongly u-shaped, with the middle quintile paying the lowest prices and the poorest and least poor paying higher prices. Patients with asthma in the poorest wealth quintile paid more for salbutamol than those in all other quintiles. Conclusion The poorest in Kenya appear to face increased barriers to accessing NCD medicines as compared with the less poor. To achieve universal health coverage, the country will need to consider pro-poor policies for improving equity in access.
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Affiliation(s)
- Peter C Rockers
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Richard O Laing
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.,Department of Demography and Population Studies, University of the Witwatersrand, Johannesburg, South Africa
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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15
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Prevalence, Awareness and Associated Risk Factors of Diabetes among Adults in Xi'an, China. Sci Rep 2017; 7:10472. [PMID: 28874777 PMCID: PMC5585342 DOI: 10.1038/s41598-017-10797-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 08/15/2017] [Indexed: 12/15/2022] Open
Abstract
The study aimed to investigate the prevalence, awareness, treatment and glycaemic control of diabetes and its associated risk factors among adults in Xi’an, China. We collected data among participants aged 18 years or older through a self-developed questionnaire and an additional health examination. A total of 8150 participants were included, with an overall prevalence of diabetes of 8.0%. Among 655 participants with diabetes, 52.5% were aware they had diabetes, 48.1% took antidiabetic treatment, and 19.1% had their fasting blood glucose level at less than 7.0 mmol/l. Older age, lower educational level, higher body mass index, larger waist circumference, having an unhealthy diet and having more comorbidities were positively associated with the risk of diabetes. Participants who were older, who had higher education and who had more comorbidities were more aware that they had diabetes. Being older age, having higher education and having more comorbidities were also factors for better treatment. Participants who were older were more likely to have their glucose level controlled. The prevalence of diabetes among adults in Xi’an is high, with suboptimal awareness, treatment, and glycaemic control rates. Comprehensive integrated strategies based on risk factors should be implemented to improve the prevention and glycaemic control of diabetes.
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16
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Wu H, Meng X, Wild SH, Gasevic D, Jackson CA. Socioeconomic status and prevalence of type 2 diabetes in mainland China, Hong Kong and Taiwan: a systematic review. J Glob Health 2017; 7:011103. [PMID: 28702177 PMCID: PMC5481892 DOI: 10.7189/jogh.07.011103] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND China is estimated to have had the largest number of people with diabetes in the world in 2015, with extrapolation of existing data suggesting that this situation will continue until at least 2030. Type 2 diabetes has been reported to be more prevalent among people with low socioeconomic status (SES) in high-income countries, whereas the opposite pattern has been found in studies from low- and middle-income countries. We conducted a systematic review to describe the cross-sectional association between SES and prevalence of type 2 diabetes in Chinese in mainland China, Hong Kong and Taiwan. METHODS We conducted a systematic literature search in Medline, Embase and Global Health electronic databases for English language studies reporting prevalence or odds ratio for type 2 diabetes in a Chinese population for different SES groups measured by education, income and occupation. We appraised the quality of included studies using a modified Newcastle-Ottawa Scale. Heterogeneity of studies precluded meta-analyses, therefore we summarized study results using a narrative synthesis. RESULTS Thirty-three studies met the inclusion criteria and were included in the systematic review. The association between education, income and occupation and type 2 diabetes was reported by 27, 19 and 12 studies, respectively. Most, but not all, studies reported an inverse association between education and type 2 diabetes, with odds ratios (OR) and 95% confidence interval (CI) ranging from 0.39 (CI not reported) to 1.52 (95% CI 0.91 - 2.54) for the highest compared to the lowest education level. The association between income and type 2 diabetes was inconsistent between studies. Only a small number of studies identified a significant association between occupation and type 2 diabetes. Retired people and people working in white collar jobs were reported to have a higher risk of type 2 diabetes than other occupational groups even after adjusting for age. CONCLUSIONS This first systematic review of the association between individual SES and prevalence of type 2 diabetes in China found that low education is probably associated with an increased prevalence of type 2 diabetes, while the association between income and occupation and type 2 diabetes is unclear.
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Affiliation(s)
- Hongjiang Wu
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Xiangrui Meng
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Danijela Gasevic
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Caroline A Jackson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
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17
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Han C, Zhang M, Luo X, Wang C, Yin L, Pang C, Feng T, Ren Y, Wang B, Zhang L, Li L, Yang X, Zhang H, Zhao Y, Zhou J, Xie Z, Zhao J, Hu D. Secular trends in the prevalence of type 2 diabetes in adults in China from 1995 to 2014: A meta-analysis. J Diabetes 2017; 9:450-461. [PMID: 27282985 DOI: 10.1111/1753-0407.12440] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 06/01/2016] [Accepted: 06/07/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The aim of the present study was to estimate trends in the prevalence of type 2 diabetes mellitus (T2DM) in adults in China. METHODS A systematic search was conducted for studies of T2DM prevalence in adults in China from 2000 to 2014. Pooled prevalence was calculated by a random-effects model. Subgroup and sensitivity analyses were performed. Chi-squared and Cochran-Mantel-Haenszel tests were used to assess differences among subgroups and pooled prevalence, respectively. RESULTS Forty-six studies (data from 1995 to 2014; 1 463 079 adults) were included in the meta-analysis. The overall prevalence of T2DM was 7.9 %. The pooled prevalence overall and by location (urban and rural), gender (male and female), and age category (18-39, 40-59, and ≥60 years) was 4.5 %, 5.1 % and 3.0 %, 4.0 % and 4.2 %, and 1.4 %, 5.0 %, and 10.3 %, respectively, from 1995 to 1999; 6.6 %, 9.3 % and 5.6 %, 7.4 % and 7.5 %, and 1.8 %, 5.9 %, and 12.4 %, respectively, from 2000 to 2004; 10.3 %, 11.8 % and 6.8 %, 10.0 % and 8.6 %, and 2.8 %, 10.3 %, and 20.0 %, respectively, from 2005 to 2009; and 8.3 %, 12.5 % and 7.6 %, 8.6 % and 8.0 %, and 3.5 %, 8.5 %, and 15.3 %, respectively, from 2010 to 2014. The prevalence increased from 5.8 % to 11.6 % with per-capita gross domestic product and differed by diagnostic criteria. CONCLUSIONS There was a trend of increasing prevalence of T2DM in adults in China from 1995 to 2009, with a decrease in 2010-14 and a greater increase over time in urban versus rural areas, males versus females, and older versus younger adults.
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Affiliation(s)
- Chengyi Han
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
- Department of Prevention and Health Care, The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, Shenzhen, China
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, China
| | - Ming Zhang
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, China
| | - Xinping Luo
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, China
| | - Chongjian Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Lei Yin
- Department of Prevention and Health Care, Military Hospital of Henan Province, Zhengzhou, China
| | - Chao Pang
- Department of Prevention and Health Care, Military Hospital of Henan Province, Zhengzhou, China
| | - Tianping Feng
- Department of Prevention and Health Care, Military Hospital of Henan Province, Zhengzhou, China
| | - Yongcheng Ren
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, China
| | - Bingyuan Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, China
| | - Lu Zhang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Linlin Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiangyu Yang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Hongyan Zhang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Junmei Zhou
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, China
| | - Zhihui Xie
- Intensive Care Unit, Zhoukou City Central Hospital, Zhoukou, China
| | - Jingzhi Zhao
- Department of Prevention and Health Care, Military Hospital of Henan Province, Zhengzhou, China
| | - Dongsheng Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
- Department of Prevention and Health Care, The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, Shenzhen, China
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, China
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18
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Ke L, Zhang Y, Wang X, Li S, Yang W, Tong N. Assessment of diabetes care and the healthcare system in economically and transport underdeveloped rural mountain areas of western China: A cross-sectional survey. J Diabetes 2017; 9:475-481. [PMID: 27249640 DOI: 10.1111/1753-0407.12433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 05/11/2016] [Accepted: 05/15/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of the present study was to assess the quality of diabetes care and characteristics of the healthcare system in underdeveloped rural mountain areas of western China. METHODS Questionnaires were used to collect data from 288 diabetic patients with a multistage cluster sampling method in Zhongjiang County (Sichuan Province) between October 2009 and April 2010. Sixty-two village clinics, 23 town health centers, and a county central hospital were included to assess the availability of diabetes-related medical resources, in addition to diabetes-related medical insurance, reimbursement policies, and manpower. RESULTS Of 288 patients, 38.2 % monitored their blood glucose regularly. Targets for fasting blood glucose (≤7 mmol/L) and blood pressure (≤130/80 mmHg) were achieved by 7.6 % and 9.7 % of patients, respectively. On average, each patient paid US$120 out of pocket annually for out-patient diabetes care, with a maximum US$86 reimbursed. The county central hospital was the only healthcare facility in the county that could provide all essential diabetes-related drugs and process-of-care measures and tests, except measures of HbA1c and the urinary albumin: creatinine ratio. Insulin was not available at village clinics, and only 29 % of village clinics had glucometers. "Certified" doctors were not available to provide primary care in village clinics. CONCLUSIONS The quality of diabetes care was quite poor in underdeveloped rural mountain areas of western China. Recommendations for further intervention research to improve diabetes healthcare include increasing investment in medical infrastructure, improving the availability of essential drugs and process measures, organizing regular diabetes patient education, and recruiting village doctors.
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Affiliation(s)
- Linqiu Ke
- Division of Endocrinology and Metabolism, West China Hospital of Sichuan University, Deyang City, China
| | - Yuwei Zhang
- Division of Endocrinology and Metabolism, West China Hospital of Sichuan University, Deyang City, China
| | - Xiaoqian Wang
- Endocrinology Division, Deyang Municipal People's Hospital, Deyang City, China
| | - Shengyong Li
- Endocrinology Unit, Zhongjiang County Central Hospital, Deyang City, China
| | - Wei Yang
- Health and Family Planning Commission of Zhongjiang County, Deyang City, China
| | - Nanwei Tong
- Division of Endocrinology and Metabolism, West China Hospital of Sichuan University, Deyang City, China
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19
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He M, Gao J, Liu W, Tang X, Tang S, Long Q. Case management of patients with Type 2 diabetes mellitus: a cross-sectional survey in Chongqing, China. BMC Health Serv Res 2017; 17:129. [PMID: 28187724 PMCID: PMC5303217 DOI: 10.1186/s12913-017-2039-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 01/19/2017] [Indexed: 11/29/2022] Open
Abstract
Background Type 2 diabetes mellitus has been identified as one of the priority diseases and included in the essential public health service package in China. This study investigated the frequency of follow-up visits and contents of care for case management of patients with Type 2 diabetes in Chongqing located in the western China, in terms of the regional practice guideline; and analyzed factors associated with the use of care. Methods A cross-sectional survey was conducted with patients diagnosed with Type 2 diabetes in two areas in Chongqing. Total 502 participants (out of 664 people eligible) completed the interview. The outcome measures included at least four follow-up visits in a year, annual HbA1c test, blood lipid test and diabetic screening for nephropathy and eyes. Logistic regression analysis was applied to examine the association between participants’ demographic and socio-economic characteristics and outcome measures. Results Over the one-year study period, 65% of participants had four or more follow-up visits. In light of the recommended tests, the proportions of having HbA1c test, blood lipid test and screening for nephropathy and eyes annually were 8, 54, 45 and 44%, respectively. After adjusting for study sites, age, sex, education, type of residence, level of income, the patients who were covered by Urban Employee Basic Medical Insurance, were enrolled in the targeted disease reimbursement program, and lived with diabetes more than five years were more likely to have regular follow-up visits and the recommended tests. Conclusions Case management for patients with Type 2 diabetes mellitus was not effectively implemented in terms of frequency of follow-up visits and recommended tests over one-year period, as indicated in the regional practice guideline.
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Affiliation(s)
- Miao He
- School of Public Health and Management, Collaborative Innovation Center of Social Risks Governance in Health, Research Center for Medicine and Social Development, Chongqing Medical University, No.1 Yixueyuan Road, Chongqing, Yuzhong district, 400016, People's Republic of China
| | - Jiaqi Gao
- School of Public Health and Management, Collaborative Innovation Center of Social Risks Governance in Health, Research Center for Medicine and Social Development, Chongqing Medical University, No.1 Yixueyuan Road, Chongqing, Yuzhong district, 400016, People's Republic of China
| | - Weiwei Liu
- School of Public Health and Management, Collaborative Innovation Center of Social Risks Governance in Health, Research Center for Medicine and Social Development, Chongqing Medical University, No.1 Yixueyuan Road, Chongqing, Yuzhong district, 400016, People's Republic of China
| | - Xiaojun Tang
- School of Public Health and Management, Collaborative Innovation Center of Social Risks Governance in Health, Research Center for Medicine and Social Development, Chongqing Medical University, No.1 Yixueyuan Road, Chongqing, Yuzhong district, 400016, People's Republic of China.
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Qian Long
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Global Health Research Center, Duke Kunshan University, Kunshan, China
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20
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Long Q, He M, Tang X, Allotey P, Tang S. Treatment of Type 2 diabetes mellitus in Chongqing of China: unaffordable care for the poor. Diabet Med 2017; 34:120-126. [PMID: 27472098 DOI: 10.1111/dme.13193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2016] [Indexed: 01/19/2023]
Abstract
AIM This study aims to investigate the medical expenditure of people with Type 2 diabetes mellitus in Chongqing, China; to explore factors that contribute to the expenditure; and to examine the financial burden placed on households, particularly poor households. METHODS A cross sectional survey was conducted with a sample of people diagnosed with Type 2 diabetes mellitus in 2014. Of the 664 people eligible, 76% were interviewed. Descriptive statistics and log-linear regression were used to examine respondents' age, sex and level education, location of residence, income and type of health insurance associated with out-of-pocket expenditure on accessing diabetes mellitus care. RESULTS In a year, average out-of-pocket expenditure on the purchase of drugs from pharmacies and having outpatient care were US $333 and US $310, respectively. The average out-of-pocket expenditure on accessing inpatient care was 3.7 times (US $1159) that of accessing outpatient care. After adjusting for age and sex, out-of-pocket expenditure on diabetes care was significantly higher for people covered by the Urban Employee Basic Medical Insurance programme and those enrolled in the identified priority diseases reimbursement programme, which provided higher reimbursement rates for outpatient and (or) inpatient care. Out-of-pocket expenditures on the purchase of drugs from pharmacies, having outpatient and inpatient care, respectively, were 9.8%, 16.2% and 62.6% of annual household income in low-income group. CONCLUSION Even with health insurance coverage, poor people with Type 2 diabetes mellitus suffered from significant financial hardship. This has significant implications for models of care and healthcare financing in China with the growing burden of diabetes.
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Affiliation(s)
- Q Long
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - M He
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - X Tang
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - P Allotey
- School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
| | - S Tang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Duke Global Health Institute, Duke University, Durham, NC, USA
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Christiani Y, Dhippayom T, Chaiyakunapruk N. Assessing evidence of inequalities in access to medication for diabetic populations in low- and middle-income countries: a systematic review. Glob Health Action 2016; 9:32505. [PMID: 27938647 PMCID: PMC5148807 DOI: 10.3402/gha.v9.32505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 11/02/2016] [Accepted: 11/04/2016] [Indexed: 11/18/2022] Open
Abstract
Background Inequalities in access to medications among people diagnosed with diabetes inlow- and middle-income countries (LMICs) is a public health concern since untreated diabetes can lead to severe complications and premature death. Objective To assess evidence of inequalities in access to medication for diabetes in adult populations of people with diagnosed diabetes in LMICs. Design We conducted a systematic review of the literature using the PRISMA-Equity guidelines. A search of five databases – PubMed, Cochrane, CINAHL, PsycINFO, and EMBASE – was conducted from inception to November 2015. Using deductive content analysis, information extracted from the selected articles was analysed according to the PRISMA-Equity guidelines, based on exposure variables (place of residence, race/ethnicity, occupation, gender, religion, education, socio-economic status, social capital, and others). Results Fifteen articles (seven quantitative and eight qualitative studies) are included in this review. There were inconsistent findings between studies conducted in different countries and regions although financial and geographic barriers generally contributed to inequalities in access to diabetes medications. The poor, those with relatively low education, and people living in remote areas had less access to diabetes medications. Furthermore, we found that the level of government political commitment through primary health care and in the provision of essential medicines was an important factor in promoting access to medications. Conclusions The review indicates that inequalities exist in accessing medication among diabetic populations, although this was not evident in all LMICs. Further research is needed to assess the social determinants of health and medication access for people with diabetes in LMICs.
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Affiliation(s)
- Yodi Christiani
- Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,CREDOS (Creative Development Strategies) Institute, Jakarta, Indonesia
| | - Teerapon Dhippayom
- Pharmaceutical Care Research Unit, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Nathorn Chaiyakunapruk
- Center of Pharmaceutical Outcomes Research, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.,School of Pharmacy, University of Wisconsin, Madison, WI, USA.,School of Population Health, University of Queensland, Brisbane, QLD, Australia;
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Su R, Cai L, Cui W, He J, You D, Golden A. Multilevel Analysis of Socioeconomic Determinants on Diabetes Prevalence, Awareness, Treatment and Self-Management in Ethnic Minorities of Yunnan Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13080751. [PMID: 27463725 PMCID: PMC4997437 DOI: 10.3390/ijerph13080751] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 07/14/2016] [Accepted: 07/19/2016] [Indexed: 01/19/2023]
Abstract
Objectives: The objective of this manuscript is to investigate socioeconomic differences in prevalence, awareness, treatment and self-management of diabetes among ethnic minority groups in Yunnan Province, China. Methods: We conducted a cross-sectional survey in a sample of 5532 Na Xi, Li Su, Dai and Jing Po ethnic minorities. Multilevel modeling was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for diabetes prevalence, as well as the other outcomes. Results: Higher individual educational level was associated with a higher rate of awareness, treatment, adherence to medicines and monitoring of blood glucose (OR = 1.87, 4.89, 4.83, 6.45; 95% CI: 1.26–2.77, 1.87–12.7, 1.95–11.9, 2.23–18.6, respectively). Diabetic respondents with better household assets tended to receive more treatment (OR = 2.81, 95% CI: 1.11–7.12) and to monitor their blood glucose (OR = 3.29, 95% CI: 1.48–7.30). Diabetic patients with better access to medical services were more likely to treat (OR = 7.09, 95% CI: 2.46–20.4) and adhere to medication (OR = 4.14, 95% CI: 1.46–11.7). Income at the contextual level was significantly correlated with diabetes prevalence, treatment and blood glucose monitoring (OR = 1.84, 3.04, 4.34; 95% CI: 1.20–2.83, 1.20–7.73, 1.45–13.0, respectively). Conclusions: Future diabetes prevention and intervention programs should take both individual and township-level socioeconomic factors into account in the study regions.
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Affiliation(s)
- Rong Su
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China.
- Department of Gerontology, The Affiliated Ganmei Hospital of Kunming Medical University, 504 Qing Nian Road, Kunming 650011, China.
| | - Le Cai
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China.
| | - Wenlong Cui
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China.
| | - Jianhui He
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China.
| | - Dingyun You
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China.
| | - Allison Golden
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China.
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Ko B, Lim J, Kim YZ, Park HS. Trends in type 2 diabetes prevalence according to income levels in Korea (1998-2012). Diabetes Res Clin Pract 2016; 115:137-9. [PMID: 26830075 DOI: 10.1016/j.diabres.2016.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/05/2015] [Accepted: 01/08/2016] [Indexed: 11/30/2022]
Abstract
There was no significant association between diabetes prevalence and income levels for either sex in 1998. However, the high income level in men and the low income level in women positively related to the odds of diabetes in 2011-2012. Preventive strategies for diabetes should consider the gender-specific economic discrepancy.
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Affiliation(s)
- B Ko
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 100-742, South Korea
| | - J Lim
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea
| | - Y Z Kim
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea
| | - H S Park
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea.
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Ge L, Wikby K, Rask M. 'Is gestational diabetes a severe illness?' exploring beliefs and self-care behaviour among women with gestational diabetes living in a rural area of the south east of China. Aust J Rural Health 2016; 24:378-384. [PMID: 27087496 DOI: 10.1111/ajr.12292] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE This study explores beliefs about illness and health and self-care behaviour among women with gestational diabetes living in a rural area of the south east of China. DESIGN A qualitative exploratory study using semi-structured interviews and qualitative content analysis. SETTING A hospital located in the outskirts of a city in the south east of China. PARTICIPANTS Seventeen women with gestational diabetes in 34-38th pregnant weeks. RESULTS The beliefs about gestational diabetes among the women in the present study were found to be bidirectional. Some of them feared the illness and its negative influence on health, while others believed that it was not a severe illness and disbelieved the diagnosis of gestational diabetes. They related their illness and health to the individual, social and natural factors. They mainly sought help from the professional sector, but did not fully comply with the professionals' advice. Diet control and exercise were their main self-care measures, but none of them self-monitored their blood glucose. They demonstrated their misunderstanding about diet control and self-monitoring of blood glucose. CONCLUSIONS This study highlighted the serious lack of knowledge, lower level of risk awareness and poor self-care behaviour among women in this group. Health professionals were found to be the most important source of knowledge about gestational diabetes for these women. The influence of Chinese culture was demonstrated. Gestational diabetes among these women can most likely be improved by training the health professionals and by health education involving individuals, families and the rural communities.
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Affiliation(s)
- Li Ge
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.,Nursing College of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Kerstin Wikby
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Mikael Rask
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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Tompkins G, Forrest LF, Adams J. Socio-Economic Differences in the Association between Self-Reported and Clinically Present Diabetes and Hypertension: Secondary Analysis of a Population-Based Cross-Sectional Study. PLoS One 2015; 10:e0139928. [PMID: 26466384 PMCID: PMC4605711 DOI: 10.1371/journal.pone.0139928] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 09/19/2015] [Indexed: 12/17/2022] Open
Abstract
Background Diabetes and hypertension are key risk factors for coronary heart disease. Prevalence of both conditions is socio-economically patterned. Awareness of presence of the conditions may influence risk behaviour and use of preventative services. Our aim was to examine whether there were socio-economic differences in awareness of hypertension and diabetes in a UK population. Method Data from the Scottish Health Survey was used to compare self-reported awareness of hypertension and diabetes amongst those found on examination to have these conditions, by socioeconomic position (SEP) (measured by occupation, education and income). Odds ratios of self-reported awareness against presence, and the sensitivity, specificity and predictive value of self-reporting as a measure of the presence of the condition, were calculated. Results Presence and self-reported awareness of both conditions increased as SEP decreased, on most measures. There was only one significant difference in awareness by SEP once other factors had been taken into account. Sensitivity showed that those in the most disadvantaged groups were most likely to self-report awareness of their hypertension, and specificity showed that those in the least disadvantaged groups were most likely to self-report awareness of its absence. There were few differences of note for diabetes. Conclusion We found no consistent pattern in the associations between SEP and the presence and self-reported awareness of hypertension and diabetes amongst those with these conditions. Without evidence of differences, it is important that universal approaches continue to be applied to the identification and management of those at risk of these and other conditions that underpin cardiovascular disease.
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Affiliation(s)
- Gerald Tompkins
- Health Education North East, Newcastle upon Tyne, United Kingdom
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lynne F. Forrest
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jean Adams
- Centre for Diet & Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
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26
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Rahman M, H SE, Islam MJ, Mostofa MG, Saadat KA. Association of socioeconomic status with diagnosis, treatment and control of hypertension in diabetic hypertensive individuals in Bangladesh: a population-based cross-sectional study. JRSM Open 2015; 6:2054270415608118. [PMID: 26688743 PMCID: PMC4601127 DOI: 10.1177/2054270415608118] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objectives This study aimed to examine if socioeconomic status could affect the likelihood of diagnosis, treatment and control of hypertension in diabetic hypertensive individuals. Design Cross-sectional nationally representative study. Settings Bangladesh. Participants This paper used data from the 2011 Bangladesh Demographic Health Survey. The analyses were based on the responses of 339 diabetes hypertensive individuals. Main outcome measures Diagnosis, treatment and control of hypertension. Results The age-adjusted prevalence of hypertension in diabetes individuals was 38.4% in the study population. Among diabetic hypertensive subjects only 65.7% had been diagnosed, 58.4% were receiving treatment and 42% controlled their hypertension. Individuals from high socioeconomic status (AOR 2.60; 95% CI 1.16–5.83) had an increased likelihood of reporting diagnosis of hypertension. Individuals from medium (AOR 2.22; 95% CI 1.11–4.46) and high socioeconomic status (AOR 3.47; 95% CI 1.59–7.58) had increased chance of receiving treatment. In addition, individuals belonging to high socioeconomic status (AOR 2.53; 95% CI 1.14–5.63) were more likely to report of controlling hypertension. Conclusions This study indicated that hypertension is more prevalent among diabetic patients. Furthermore, diabetic hypertensive patients from the low socioeconomic status group are also less likely to be diagnosed and also less likely to receive treatment for hypertension. In addition, diabetic hypertensive patients from the low socioeconomic status were less likely to control hypertension compared with an individual belonging to the high socioeconomic status group. This reduced likelihood of receiving proper treatment will lead to a rapid increase in the prevalence of macrovascular and microvascular diseases among diabetic hypertensive patients.
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Affiliation(s)
- Mosiur Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Syed Emdadul H
- UChicago Research Bangladesh, House 4, Road 2/B, Sector 4, Uttra-1230, Dhaka, Bangladesh
| | - Md Jahirul Islam
- Ministry of Health and Family Welfare, Bangladesh Secretariat, Dhaka 1000, Bangladesh
| | - Md Golam Mostofa
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi 6205, Bangladesh
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Zhu S, Hu J, McCoy TP, Li G, Zhu J, Lei M, Yuan J, Peng J, Kong L. Socioeconomic Status and the Prevalence of Type 2 Diabetes Among Adults in Northwest China. DIABETES EDUCATOR 2015; 41:599-608. [PMID: 26246592 DOI: 10.1177/0145721715598382] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of the study was to investigate (1) the associations of socioeconomic status, lifestyle risk factors, and the prevalence of newly diagnosed type 2 diabetes and (2) the mediating effects of lifestyle risk factors on the association of socioeconomic status and the prevalence of newly diagnosed type 2 diabetes among Chinese adults in northwest China. METHODS Based on a correlational design and random multistage sampling in communities (N = 3243), data were collected through face-to-face interviews and anthropometric measurements. Education, occupation, and income were considered indicators of socioeconomic status. RESULTS Approximately 7.5% persons interviewed had newly diagnosed type 2 diabetes. Chi-square analyses showed that higher socioeconomic indicators (higher income, nonmanual occupation) were associated with increased risk. Lifestyle risk factors, including alcohol use, unhealthy diet, and higher body mass index, were significantly positively associated with type 2 diabetes. Adjusting for demographic characteristics, hierarchical logistic regression analyses showed that unhealthy diet and high body mass index were significantly associated with type 2 diabetes. CONCLUSIONS Higher incomes and nonmanual occupations were related to a greater prevalence of type 2 diabetes, and high body mass index mediated these associations. These findings suggest that interventions for type 2 diabetes in China should be targeted at populations with high socioeconomic status and nonmanual occupations to reduce lifestyle risk factors and prevent diabetes.
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Affiliation(s)
- Shuzhen Zhu
- School of Nursing, Hubei University of Medicine, Shiyan City, Hubei Province, China (Ms S. Zhu)
| | - Jie Hu
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA (Dr Hu, Dr McCoy)
| | - Thomas P McCoy
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA (Dr Hu, Dr McCoy)
| | - Guangwu Li
- School of Biomedical Engineering, Hubei University of Medicine, Hubei Province, China (Mr Li)
| | - Jianyong Zhu
- Department of Diabetes, Affiliated People's Hospital of Hubei University of Medicine, Shiyan City, Hubei Province, China (Mr J. Zhu, Ms Peng)
| | - Meirong Lei
- School of Nursing, Hubei University of Medicine, Shiyan City, Hubei Province, China (Ms S. Zhu),School of Nursing, Hubei University of Medicine, Hubei Province, China (Ms Lei, Mr Yuan)
| | - Jie Yuan
- School of Nursing, Hubei University of Medicine, Hubei Province, China (Ms Lei, Mr Yuan)
| | - Jingxia Peng
- Department of Diabetes, Affiliated People's Hospital of Hubei University of Medicine, Shiyan City, Hubei Province, China (Mr J. Zhu, Ms Peng)
| | - Linglin Kong
- School of Nursing, Hubei University of Science and Technology, Hubei Province, China (Ms Kong)
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Rahman M, Nakamura K, Kizuki M. Socioeconomic differences in the prevalence, awareness, and control of diabetes in Bangladesh. J Diabetes Complications 2015; 29:788-93. [PMID: 25981122 DOI: 10.1016/j.jdiacomp.2015.04.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 04/16/2015] [Accepted: 04/17/2015] [Indexed: 11/26/2022]
Abstract
AIMS To explore the association of the socioeconomic status (SES) in Bangladesh with diabetes prevalence, awareness, and control. METHODS A population sample of 7540 individuals from the 2011 Bangladesh Demographic Health Survey was used. A composite variable of education and wealth calculated the SES indicator. Besides prevalence (age-sex adjusted) of diabetes and pre-diabetes, three other points were analyzed with the socio-demographic characteristics: awareness of diabetes, diabetics receiving medication and adequacy of treatment (measured by achieving normal fasting plasma glucose). RESULTS The age-sex adjusted prevalence of diabetes and pre-diabetes were 10.8% and 25.0%, respectively, in the study population (n=7540). Prevalence of diabetes was 7.2% in the low SES (n=2147) and 17.9% in the high SES group (n=2,418). Among diabetics (n=879), 39.7% were aware of their disease, 35.5% were receiving medication, and 13.0% were receiving adequate medication. Diabetic patients from the medium or high SES group had an increased likelihood of being aware of their disease and of receiving medication. CONCLUSIONS Contrary to other developed countries, diabetes in Bangladesh is more prevalent among the higher SES group. Due to the high prevalence of pre-diabetes, lack of awareness of diabetes and less likelihood of receiving adequate treatment in lower SES group, there is potential for the rapid increase of diabetes. Urgent preventive measures are needed to control the impending diabetes epidemic.
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Affiliation(s)
- Mosiur Rahman
- Department of International Health and Medicine, Division of Public Health, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Keiko Nakamura
- Department of International Health and Medicine, Division of Public Health, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masashi Kizuki
- Health Promotion, Division of Public Health, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Cao P, Wang K, Zhang H, Zhao R, Li C. Factors Influencing the Hospitalization Costs of Patients With Type 2 Diabetes. Asia Pac J Public Health 2015; 27:55S-60S. [PMID: 25834270 DOI: 10.1177/1010539515573831] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This study aims to research the factors influencing the hospitalization costs of patients with type 2 diabetes, so as to provide some references for reducing their economic burden. Based on the Hospital Information System of a 3A grade hospital in China, we analyzed 2970 cases with type 2 diabetes during 2005-2012. Both the number of inpatients and the hospitalization costs had increased in the study period. Using multiple linear regression analysis, we found that patients in Urban Employee Basic Medical Insurance had higher costs than those in New Rural Cooperative Medical Scheme. We also found hospitalization costs to be higher in male patients and older patients, patients who stayed more days at hospital and who had surgeries, patients who had at least 1 complication, and patients whose admission status was emergency. After standardizing the regression coefficients, we found that the hospital stay, the forms of payment, and presence of complications were the first 3 factors influencing hospitalization costs in our study. In conclusion, the hospitalization costs of patients with type 2 diabetes could be influenced by age, gender, forms of payment, hospital stay, admission status, complications, and surgery. Medical workers in the studied region should take actions to reduce the duration of hospital stay for diabetic patients and prevent relevant complications. What is more, medical insurance needs further improvement.
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Affiliation(s)
- Ping Cao
- Jing Men No. 2 People’s Hospital, Jing Men, China
| | - Kaixiu Wang
- Jing Men No. 2 People’s Hospital, Jing Men, China
| | - Hua Zhang
- Jing Men No. 2 People’s Hospital, Jing Men, China
| | - Rongzhi Zhao
- Jing Men No. 2 People’s Hospital, Jing Men, China
| | - Chenglong Li
- Jing Men No. 2 People’s Hospital, Jing Men, China
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Chen PC, Tsai CY, Woung LC, Lee YC. Socioeconomic disparities in preventable hospitalization among adults with diabetes in Taiwan: a multilevel modelling approach. Int J Equity Health 2015; 14:31. [PMID: 25889800 PMCID: PMC4377057 DOI: 10.1186/s12939-015-0160-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 03/05/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Literature shows socioeconomic disparities are related to various aspects of diabetes care. However, few studies have explored the relationship between socioeconomics and healthcare outcomes, particularly with regard to preventable hospitalization. This cohort study employed hierarchical modelling to evaluate the role of socioeconomics at both the individual and regional levels in order to examine disparities associated with the preventable hospitalization of diabetes patients in Taiwan. METHODS This study employed the Longitudinal Health Insurance Database 2010, which provided a representative cohort comprising one million people enrolled in Taiwan's National Health Insurance in 2010. All diabetes patients aged 18 and older who received regular care in 2010 were included in this study. The outcome examined in this study was diabetes-related preventable hospitalization during the period of 2010 to 2011. Socioeconomic status at the individual level was measured according to income and at the regional level according to level of urbanization and the proportion of residents who had completed college education. Control variables included age, gender, comorbidities, time of diabetes diagnosis, participated in the pay-for-performance program status, and the characteristics of regular sources of care, including the level of the facility (i.e., medical centre, regional hospital, local hospital, outpatient clinic) and ownership. Statistical analysis was performed using generalized linear mixed models. RESULTS A total of 57,791 patients from 25 regions diagnosed with type-2 diabetes mellitus were identified in the National Health Insurance claim data for the year 2010. 1040 of these patients (1.8%) had at least one diabetes-related preventable hospitalization event during the period of 2010-2011. After controlling for the characteristics of patients and health care providers, our results show that dependents and patients in low and middle income brackets (OR = 2.48, 2.44, and 2.08 respectively) as well as those living in regions with a low, median, or high education bracket (OR = 1.32, 1.38, and 1.46 respectively) face a higher probability of preventable hospitalization. CONCLUSIONS Our results demonstrate that the socioeconomic effects of higher education at the regional level as well as income at the individual level are important factors which affect disparities in diabetes-related preventable hospitalization.
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Affiliation(s)
- Pei-Ching Chen
- Institute of Health and Welfare Policy, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City, 112, Taiwan. .,Department of Education and Research, Taipei City Hospital, No.145, Zhengzhou Rd, Datong Dist, Taipei City, 103, Taiwan.
| | - Ching-Yao Tsai
- Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, No.145, Zhengzhou Rd, Datong Dist, Taipei City, 103, Taiwan. .,Institute of Public Health, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City, 112, Taiwan.
| | - Lin-Chung Woung
- Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, No.145, Zhengzhou Rd, Datong Dist, Taipei City, 103, Taiwan. .,Institute of Hospital and Health Care Administration, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City, 112, Taiwan.
| | - Yue-Chune Lee
- Institute of Health and Welfare Policy, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City, 112, Taiwan.
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A cross-sectional study of diabetic knowledge in West Bengal, India: an analysis based on access to health care. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0293-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Guan M. Ethnic Difference of Disease Prevalence in Rural China: Examples and Explanations. Health (London) 2015. [DOI: 10.4236/health.2015.74052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wang C, Yu Y, Zhang X, Li Y, Kou C, Li B, Tao Y, Zhen Q, He H, Kanu JS, Huang X, Han M, Liu Y. Awareness, treatment, control of diabetes mellitus and the risk factors: survey results from northeast China. PLoS One 2014; 9:e103594. [PMID: 25068894 PMCID: PMC4113441 DOI: 10.1371/journal.pone.0103594] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 07/02/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The awareness, treatment and control of diabetes mellitus (DM) can effectively reflect on the social status of diabetes conditions. Although several researchers have investigated the awareness, treatment and control rates of diabetes mellitus in China, little is known about their association with risk factors. This study aims to examine the relationship between risk factors and awareness, treatment and control of diabetes mellitus in northeast China. METHODS A cross-sectional survey was conducted in 2012. Multistage stratified random cluster sampling design was used to select participants aged 18 to 79 years old. The analysis was based on a representative sample of 1,854 adult subjects. Multivariable logistic regression analysis was used to examine socio-demographic factors associated with the levels of awareness, treatment and control of diabetes mellitus. RESULTS The awareness, treatment, and control rates of diabetes mellitus were 64.1%, 52.9% and 44.2%, respectively. In the multivariable logistic regression analysis, family history of diabetes was significantly positively associated with awareness (OR, 2.145; 95% CI, 1.600-2.875) and treatment (OR, 2.021; 95% CI, 1.559-2.619) of diabetes mellitus, while negatively associated with control (OR, 0.671; 95% CI, 0.529-0.951). Cigarette smokers and alcohol drinkers were less likely than non-smokers and non-drinkers to be aware of their blood glucose levels (OR, 0.895, 0.614; 95% CI, 0.659-1.216, 0.446-0.844, respectively). Participants who frequently exercise were more likely to be aware of their diabetic conditions than people who never or rarely exercise (OR, 2.003; 95% CI, 1.513-2.651). CONCLUSIONS We found that the awareness and treatment of diabetes mellitus were positively associated with age and were high in participants with a family history of diabetes and those who exercise frequently, but low for cigarette smokers and alcohol drinkers. Participants with a family history of diabetes had their diabetic condition poorly controlled.
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Affiliation(s)
- Chang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun City, Jilin Province, P.R. China
| | - Yaqin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun City, Jilin Province, P.R. China
| | - Xiangyang Zhang
- Beijing Hui-Long-Guan hospital, Peking University, Beijing, P.R. China
| | - Yong Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun City, Jilin Province, P.R. China
| | - Changgui Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun City, Jilin Province, P.R. China
| | - Bo Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun City, Jilin Province, P.R. China
| | - Yuchun Tao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun City, Jilin Province, P.R. China
| | - Qing Zhen
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun City, Jilin Province, P.R. China
| | - Huan He
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun City, Jilin Province, P.R. China
| | - Joseph Sam Kanu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun City, Jilin Province, P.R. China
| | - Xufeng Huang
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Mei Han
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Yawen Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun City, Jilin Province, P.R. China
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Zuo H, Shi Z, Hussain A. Prevalence, trends and risk factors for the diabetes epidemic in China: a systematic review and meta-analysis. Diabetes Res Clin Pract 2014; 104:63-72. [PMID: 24468097 DOI: 10.1016/j.diabres.2014.01.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 09/02/2013] [Accepted: 01/01/2014] [Indexed: 01/21/2023]
Abstract
AIMS To describe the prevalence and trends of diabetes and to quantitatively assess its risk factors in mainland China. METHODS Thirty-one epidemiological studies were identified by a systematic search of four databases. Prevalence estimates were mapped and summarized by meta-analysis in each region of China. The pooled ORs and 95% CIs of risk factors for diabetes were also calculated. RESULTS There was a large geographical imbalance with regard to the prevalence of diabetes. Region-pooled prevalence was highest in the eastern region (8.0%, 95% CI: 6.1-10.0%) and lowest in the western region (4.6%, 95% CI: 3.3-6.0%), which was consistent with regional levels of economic development. The overall prevalence of diabetes has been increasing since 1980. Traditional risk factors such as age, family history of diabetes, obesity, hypertension and elevated triglycerides were found to be associated with diabetes. In addition, urban residence and being from ethnic minorities were also significantly associated. CONCLUSION Based on the meta-analyses, we found that the prevalence of diabetes is different in different parts of China but it has been increasing sharply during the last three decades. Some risk factors were quantitatively derived in the study, which are free from the diversity of a single sample.
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Affiliation(s)
- Hui Zuo
- Department of Nutrition and Food Hygiene, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China; Section for International Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Zumin Shi
- Department of Nutrition and Food Hygiene, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China; Discipline of Medicine, University of Adelaide, Adelaide, Australia.
| | - Akhtar Hussain
- Section for International Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
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Carpenter DO. Environmental exposure in indigenous communities: an international perspective. REVIEWS ON ENVIRONMENTAL HEALTH 2014; 29:3-4. [PMID: 24552955 DOI: 10.1515/reveh-2014-0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 01/15/2014] [Indexed: 06/03/2023]
Abstract
There are more than 7000 spoken languages in the world today and many others that have already disappeared. The number of languages in relation to the number of countries (192 members of the United Nations) gives some indication of the number of indigenous communities there are in the world. Many of these communities are at various stages of integration into more dominant cultures, but many others struggle to maintain a traditional lifestyle. Many are subsistence communities that depend upon local sources of food and whose way of life is threatened by encroachment of more dominant cultures. There are, of course, different environmental threats in the various communities, but they fall into several categories that are common to many of them. There is often lack of access to medical care and disease-protective actions like immunizations. There is greater vulnerability than in more conventional societies to inclement weather, and this will become more serious with climate change. There is often contamination of local traditional animal and plant foods by chemicals because of long-range transport of contaminants by air or water or because of industries located in geographic areas close to indigenous communities where there is little governmental regulation. Life expectancy in many indigenous communities is much less than in more developed mainstream societies. However, these problems, which are widely viewed as being caused by poverty and lack of education, are balanced by the value to these communities of maintaining a traditional lifestyle that would otherwise simply disappear into the mainstream cultures of the various countries.
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Cunningham-Myrie C, Younger-Coleman N, Tulloch-Reid M, McFarlane S, Francis D, Ferguson T, Gordon-Strachan G, Wilks R. Diabetes mellitus in Jamaica: sex differences in burden, risk factors, awareness, treatment and control in a developing country. Trop Med Int Health 2013; 18:1365-78. [PMID: 24128301 DOI: 10.1111/tmi.12190] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The objective of this study was to provide valid estimates of the burden of and risk factors for diabetes mellitus by sex in Jamaica, a predominantly Black, middle-income and developing country. METHODS The Jamaica Health and Lifestyle Survey 2008 examined a nationally representative sample of 2848 Jamaicans aged 15-74. Parameter estimates and 95% confidence intervals [CI] were weighted for non-response as well as age and sex of the source population. Sex differences in risk factors and diabetes prevalence, awareness, treatment and control were estimated in multivariable models. Population-attributable fractions (PAFs) of obesity on diabetes mellitus were estimated in both sexes. RESULTS The prevalence of diabetes mellitus was 7.9% (95% CI: 6.7-9.1%), significantly higher in women than men 9.3% vs. 6.4% (P = 0.02) and increasing with age. Seventy-six percentage of persons with diabetes mellitus were aware of their status; urban women and rural men were less likely to be aware. Diabetes control (43% overall) was less common in higher-income men, but more common in higher-income women. Persons without health insurance were less likely to control their diabetes. The prevalence of diabetes risk factors was higher in women than men. Increased waist circumference (≥94 cm [men]/≥80 cm [women]), overweight/obesity (body mass index ≥ 25 kg/m(2)) and low physical activity/inactivity were associated with PAFs for diabetes mellitus of 27%, 37% and 15%, respectively, in men and 77%, 54% and 24%, respectively, in women. CONCLUSIONS Prevalence of diabetes mellitus and its risk factors is high in Jamaica, especially among women, and national programmes to stem the diabetes mellitus epidemic should take these sex differences into consideration.
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Affiliation(s)
- Colette Cunningham-Myrie
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica; Tropical Medicine Research Institute, The University of the West Indies, Kingston, Jamaica
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Zhang H, Xu W, Dahl AK, Xu Z, Wang HX, Qi X. Relation of socio-economic status to impaired fasting glucose and Type 2 diabetes: findings based on a large population-based cross-sectional study in Tianjin, China. Diabet Med 2013; 30:e157-62. [PMID: 23397898 DOI: 10.1111/dme.12156] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 11/09/2012] [Accepted: 02/05/2013] [Indexed: 11/28/2022]
Abstract
AIMS Studies on the relationship between socio-economic status and Type 2 diabetes mellitus in the Chinese population are sparse. We aimed to examine the relation of socio-economic status as represented by income, education and occupation to impaired fasting glucose, Type 2 diabetes, and the control of Type 2 diabetes in a large Chinese population. METHODS This study included 7315 individuals who were aged 20-79 years and living in Tianjin, China. Impaired fasting glucose and Type 2 diabetes were ascertained according to the 1999 World Health Organization criteria. Data were analysed using multinomial and binary logistic regression, with adjustment for potential confounders. RESULT Among all participants, 532 (7.3%) persons had impaired fasting glucose, 688 (9.4%) persons had Type 2 diabetes, including 288 (3.9%) previously undiagnosed Type 2 diabetes. In fully adjusted multinomial logistic regression, compared with higher income (≥ 2000 yuan, $243.3/month), lower income (< 1000 yuan, $121.70/month) showed odds ratios (95% confidence intervals) of 3.31 (2.48-4.41) for impaired fasting glucose, 4.50 (3.07-6.61) for undiagnosed Type 2 diabetes and 4.56 (3.20-6.48) for diagnosed Type 2 diabetes. These results remained significant in the analysis stratified by education and occupation. Furthermore, persons who were retired were more likely to have impaired fasting glucose [odds ratio 1.91 (1.40-2.45)], undiagnosed Type 2 diabetes [odds ratio 2.01) 1.40-2.89] and diagnosed Type 2 diabetes [odds ratio 3.02 (2.12-4.22)]. Among the patients with Type 2 diabetes previously diagnosed, lower education (less than senior high school), non-manual work and unemployment were related to worse glycaemic control (fasting blood glucose level > 8.5 mmol/l). CONCLUSIONS Lower income and retirement are associated with increased odds of impaired fasting glucose and Type 2 diabetes in Tianjin, China. Education and occupation may play a role in glycaemic control among patients with Type 2 diabetes.
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Affiliation(s)
- H Zhang
- Department of Epidemiology, School of Public Health, Tianjin Medical University, Tianjin, China
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Xu S, Ming J, Xing Y, Gao B, Yang C, Ji Q, Chen G. Regional differences in diabetes prevalence and awareness between coastal and interior provinces in China: a population-based cross-sectional study. BMC Public Health 2013; 13:299. [PMID: 23556471 PMCID: PMC3703289 DOI: 10.1186/1471-2458-13-299] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 01/14/2013] [Indexed: 12/14/2022] Open
Abstract
Background Most studies on diabetes prevalence and awareness in China are regional or about a single province, and differences between coastal and interior provinces have not been discussed even in the nation-based studies. The aim of this study was to determine regional differences in diabetes prevalence and awareness between coastal and interior provinces, and to identify the factors associated with diabetes prevalence and awareness. Methods Provinces Fujian and Shaanxi were chosen to represent the coastal and interior provinces, respectively. The data of two provinces were from the China National Diabetes and Metabolic Disorders Study 2007–08. A total of 5926 people (Fujian 2672 and Shaanxi 3254) aged above 20 years were included as participants in the study. Age-standardized prevalence and awareness were compared between provinces. Logistic regression analysis was performed not only to examine risk factors of diabetes prevalence and awareness, but also to examine the association between regional difference and diabetes prevalence and awareness. Results The age-standardized prevalence of diabetes in Fujian was higher than that in Shaanxi among total (11.5% vs. 8.0%), male (13.6% vs. 8.9%) and female (10.8% vs. 7.4%) populations. Diabetes awareness for total and male population in Fujian was higher than that in Shaanxi (42.3% vs. 34.9% and 46.8% vs. 35.2%, respectively). Age, sex, central obesity, family history of diabetes, and metabolic risk factors were all significantly associated with diabetes prevalence in both provinces. However, cigarette smoking was significantly associated with prevalence in Fujian and physical activity was significantly associated with the prevalence in Shaanxi. Family history of diabetes was the only independent risk factor of diabetes awareness in both provinces. After being adjusted for all listed risk factors, the regional difference of diabetes prevalence was still significant, but that of diabetes awareness lost significance. Conclusions Both diabetes prevalence and awareness were higher in coastal provinces and lower in interior provinces in China. Lifestyle risk factors were found to contribute differently to diabetes prevalence in the two provinces and other unknown risk factors may account for differences of diabetes prevalence between provinces. In addition, family history of diabetes was the only independent risk factor in both provinces.
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Affiliation(s)
| | | | | | | | | | - Qiuhe Ji
- Department of Endocrinology, First Affiliated Hospital of Fourth Military Medical University, 169 Changle Road West, Xi'an, China.
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Li MZ, Su L, Liang BY, Tan JJ, Chen Q, Long JX, Xie JJ, Wu GL, Yan Y, Guo XJ, Gu L. Trends in prevalence, awareness, treatment, and control of diabetes mellitus in mainland china from 1979 to 2012. Int J Endocrinol 2013; 2013:753150. [PMID: 24288530 PMCID: PMC3830848 DOI: 10.1155/2013/753150] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/29/2013] [Accepted: 09/03/2013] [Indexed: 12/25/2022] Open
Abstract
Diabetes mellitus (DM) is one of the primary causes of premature death and disability worldwide. We performed a systematic review and meta-analysis of the published literature regarding the trends in prevalence, awareness, treatment, and control of diabetes mellitus in mainland China. PUBMED, EMBASE, Chinese Biomedical Database, China National Infrastructure database, Chinese Wan Fang database, and Chongqing VIP database were searched. Fifty-six eligible studies were included. Increasing trends in the prevalence, treatment, and control of diabetes in mainland China from 1979 to 2012 were observed. The pooled prevalence, awareness, treatment, and control of diabetes mellitus were 6.41%, 45.81%, 42.54%, and 20.87%, respectively. A higher prevalence of diabetes mellitus was found in urban (7.48%, 95%CI = 5.45~9.50) than rural (6.53%, 95%CI = 4.30~8.76) areas. Furthermore, an increasing chronological tendency was shown in different subgroups of age with regard to the prevalence of diabetes. A higher awareness of DM was found in urban (44.25%, 95%CI = 32.60~55.90) than rural (34.27%, 95%CI = 21.00~47.54) populations, and no significant differences were found in the treatment, and control of diabetes among the subgroups stratified by gender and location. From 1979 to 2012, the prevalence, treatment, and control of diabetes mellitus increased; nevertheless, there was no obvious improvement in the awareness of diabetes.
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Affiliation(s)
- Min-zhi Li
- First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, Guangxi 530023, China
| | - Li Su
- School of Public Health of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Bao-yun Liang
- First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, Guangxi 530023, China
| | - Jin-jing Tan
- First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, Guangxi 530023, China
| | - Qing Chen
- First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, Guangxi 530023, China
| | - Jian-xiong Long
- School of Public Health of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Juan-juan Xie
- First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, Guangxi 530023, China
| | - Guang-liang Wu
- First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, Guangxi 530023, China
| | - Yan Yan
- First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, Guangxi 530023, China
| | - Xiao-jing Guo
- School of Public Health of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Lian Gu
- First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, Guangxi 530023, China
- Department of Internal Neurology, First Affiliated Hospital, Guangxi University of Chinese Medicine, 89-9 Dongge Road, Nanning, Guangxi, 530023, China
- *Lian Gu:
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Ma Y, Zhang L, Chen Q. China's new cooperative medical scheme for rural residents: popularity of broad coverage poses challenges for costs. Health Aff (Millwood) 2012; 31:1058-64. [PMID: 22566447 DOI: 10.1377/hlthaff.2009.0808] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
One of the components in China's massive health reform effort is the New Cooperative Medical Scheme, which is intended to provide affordable health insurance, especially to the rural poor. This program offers three options with different benefits and costs to county health officials, who select one of the options to make available to local residents. Data were obtained from the New Cooperative Medical Scheme survey conducted by the Chinese Ministry of Health and the World Bank in 2005, which covered more than 47,000 people living in twenty-seven counties, to determine participation levels, identify which option was most attractive, and characterize the impact that each option had on care and costs. Our study found that those participants with the most limited coverage might have delayed seeking care, while the broadest coverage--the "Cadillac option"--was the most popular. Yet if this generous package were to be broadly offered, health costs would become unsustainable. Therefore, the Chinese government must consider which costs to cover for people in economically depressed rural areas.
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Affiliation(s)
- Yuqin Ma
- Institute of Military Health Management, Second Military Medical University, Shanghai, China.
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Elwell-Sutton TM, Jiang CQ, Zhang WS, Cheng KK, Lam TH, Leung GM, Schooling CM. Inequality and inequity in access to health care and treatment for chronic conditions in China: the Guangzhou Biobank Cohort Study. Health Policy Plan 2012; 28:467-79. [DOI: 10.1093/heapol/czs077] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lorga T, Aung MN, Naunboonruang P, Thinuan P, Praipaksin N, Deesakul T, Inwan U, Yingtaweesak T, Manokulanan P, Suangkaew S, Payaprom A. Predicting prediabetes in a rural community: a survey among the Karen ethnic community, Thasongyang, Thailand. Int J Gen Med 2012; 5:219-25. [PMID: 22399865 PMCID: PMC3295619 DOI: 10.2147/ijgm.s27876] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Diabetes is a growing epidemic in both urban and rural communities worldwide. Aim We aimed to survey fasting plasma glucose (FPG) status and awareness of diabetes in the rural Karen ethnic community. We investigated the predictors of impaired fasting plasma glucose (IFG) status, which would be easily applicable for prevention of diabetes in a rural community. Materials and methods This was a community-based cross-sectional study conducted at Thasongyang, the most north-western district in Thailand. A total of 299 Karen ethnic rural residents were included in the study. FPG, body mass index, and waist circumference were prospectively measured. We assessed the awareness of diabetes and lifestyle-related health behavior with closed questionnaires in a rural community setting. Results On screening for FPG, 16.72% of the Karen ethnic residents had hyperglycemia: 3.68% in the diabetic range and 13.04% in the prediabetic range respectively. After adjustment for age, sex, and BMI, waist circumference (adjusted odds ratio [aOR] 3.5, 95% confidence interval [CI] 1.29–9.57), and having a diabetic blood relative (aOR 4.6, CI 1.81–11.71) are significant predictors of IFG status. Conclusion It is necessary to promote awareness of diabetes among the Karen ethnic community. Application of simple evidence-based predictors of the prediabetic state may lead to timely and effective prevention of diabetes in rural settings.
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Affiliation(s)
- Thaworn Lorga
- Boromarajonani College of Nursing Nakhon Lampang (BCNLP), Lampang, Thailand
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Le C, Lin L, Jun D, Jianhui H, Keying Z, Wenlong C, Ying S, Tao W. The economic burden of type 2 diabetes mellitus in rural southwest China. Int J Cardiol 2011; 165:273-7. [PMID: 21908062 DOI: 10.1016/j.ijcard.2011.08.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 08/17/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study was conducted in order to estimate the economic burden of diabetes in a given year in rural Yunnan province of China, including direct, indirect and intangible costs. METHODS A cross-sectional survey was conducted in rural southwest China in early 2011 among 9396 consenting individuals aged ≥ 18 years. Information on participants' demographic characteristics, and economic consequences and related aspects of diabetes were obtained using a standard questionnaire. Fasting blood sugar level was also measured for each individual. Years of life lost (YLL) due to diabetes was estimated using medical death certificates. A prevalence-based cost-of-illness method was used to estimate the economic burden of diabetes. RESULTS The overall prevalence and YLL of diabetes was 6.5% and 1168.1 years in the study population, respectively. Total cost of illness related to diabetes was estimated to be $46.8 million. Mean unit direct medical costs, direct non-medical costs, morbidity costs, mortality costs, intangible costs, and cost of illness were $863.2, $44.6, $59.7, $7797.7, $936.2, and $9686.6, respectively. Direct costs accounted for the largest proportion of the economic costs of diabetes. Age was positively associated with direct costs whereas negatively associated with indirect costs. Patients aged 45-59 years incurred the highest intangible costs. Both indirect and intangible costs increased with level of education. CONCLUSIONS Diabetes is a major public health problem in terms of morbidity and economic burden in rural southwest China. The region should increase investment in the further control of diabetes, and improvement of patient quality of life.
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Affiliation(s)
- Cai Le
- 1168 Yu Hua street Chun Rong Road, Cheng Gong New City, Department of Health Management and Economics, School of Public Health, Kunming Medical University, Kunming, Yunnan Province, 650500, China.
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