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Rural-Urban Differences in Diabetes Care and Control in 42 Low- and Middle-Income Countries: A Cross-sectional Study of Nationally Representative Individual-Level Data.
Flood, David; Geldsetzer, Pascal; Agoudavi, Kokou; Aryal, Krishna K; Brant, Luisa Campos Caldeira; Brian, Garry; Dorobantu, Maria; Farzadfar, Farshad; Gheorghe-Fronea, Oana; Gurung, Mongal Singh; Guwatudde, David; Houehanou, Corine; Jorgensen, Jutta M Adelin; Kondal, Dimple; Labadarios, Demetre; Marcus, Maja E; Mayige, Mary; Moghimi, Mana; Norov, Bolormaa; Perman, Gastón; Quesnel-Crooks, Sarah; Rashidi, Mohammad-Mahdi; Moghaddam, Sahar Saeedi; Seiglie, Jacqueline A; Bahendeka, Silver K; Steinbrook, Eric; Theilmann, Michaela; Ware, Lisa J; Vollmer, Sebastian; Atun, Rifat; Davies, Justine I; Ali, Mohammed K; Rohloff, Peter; Manne-Goehler, Jennifer.
Affiliation
  • Flood D; Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI.
  • Geldsetzer P; Center for Indigenous Health Research, Wuqu' Kawoq, Tecpán, Guatemala.
  • Agoudavi K; Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala.
  • Aryal KK; Division of Primary Care and Population Health, Stanford University, Stanford, CA.
  • Brant LCC; Chan Zuckerberg Biohub, San Francisco, CA.
  • Brian G; Togo Ministry of Health, Lome, Togo.
  • Dorobantu M; Public Health Promotion and Development Organization, Kathmandu, Nepal.
  • Farzadfar F; Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
  • Gheorghe-Fronea O; Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
  • Gurung MS; The Fred Hollows Foundation New Zealand, Auckland, New Zealand.
  • Guwatudde D; University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
  • Houehanou C; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
  • Jorgensen JMA; University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
  • Kondal D; Cardiology Department, Emergency Hospital Bucharest, Bucharest, Romania.
  • Labadarios D; Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan.
  • Marcus ME; Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda.
  • Mayige M; Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin.
  • Moghimi M; Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
  • Norov B; Public Health Foundation of India, Gurugram, India.
  • Perman G; Centre for Chronic Disease Control, New Delhi, India.
  • Quesnel-Crooks S; Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
  • Rashidi MM; Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany.
  • Moghaddam SS; National Institute for Medical Research, Dar es Salaam, Tanzania.
  • Seiglie JA; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
  • Bahendeka SK; Division of Nutrition, National Center for Public Health, Ulaanbaatar, Mongolia.
  • Steinbrook E; Department of Public Health, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
  • Theilmann M; Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago.
  • Ware LJ; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
  • Vollmer S; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
  • Atun R; Diabetes Unit, Massachusetts General Hospital, Boston, MA.
  • Davies JI; Saint Francis Hospital Nsambya, Kampala, Uganda.
  • Ali MK; Uganda Martyrs University, Kampala, Uganda.
  • Rohloff P; University of Michigan Medical School, Ann Arbor, MI.
  • Manne-Goehler J; Heidelberg Institute of Global Health, Heidelberg University and University Hospital, Heidelberg, Germany.
Diabetes Care ; 45(9): 1961-1970, 2022 09 01.
Article in En | MEDLINE | ID: mdl-35771765
OBJECTIVE: Diabetes prevalence is increasing rapidly in rural areas of low- and middle-income countries (LMICs), but there are limited data on the performance of health systems in delivering equitable and effective care to rural populations. We therefore assessed rural-urban differences in diabetes care and control in LMICs. RESEARCH DESIGN AND METHODS: We pooled individual-level data from nationally representative health surveys in 42 countries. We used Poisson regression models to estimate age-adjusted differences in the proportion of individuals with diabetes in rural versus urban areas achieving performance measures for the diagnosis, treatment, and control of diabetes and associated cardiovascular risk factors. We examined differences across the pooled sample, by sex, and by country. RESULTS: The pooled sample from 42 countries included 840,110 individuals (35,404 with diabetes). Compared with urban populations with diabetes, rural populations had ∼15-30% lower relative risk of achieving performance measures for diabetes diagnosis and treatment. Rural populations with diagnosed diabetes had a 14% (95% CI 5-22%) lower relative risk of glycemic control, 6% (95% CI -5 to 16%) lower relative risk of blood pressure control, and 23% (95% CI 2-39%) lower relative risk of cholesterol control. Rural women with diabetes had lower achievement of performance measures relating to control than urban women, whereas among men, differences were small. CONCLUSIONS: Rural populations with diabetes experience substantial inequities in the achievement of diabetes performance measures in LMICs. Programs and policies aiming to strengthen global diabetes care must consider the unique challenges experienced by rural populations.
Subject(s)

Full text: 1 Collection: 01-internacional Health context: 1_ASSA2030 / 2_ODS3 Database: MEDLINE Main subject: Rural Population / Diabetes Mellitus Type of study: Etiology_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Aspects: Determinantes_sociais_saude Limits: Female / Humans / Male Language: En Journal: Diabetes Care Year: 2022 Document type: Article

Full text: 1 Collection: 01-internacional Health context: 1_ASSA2030 / 2_ODS3 Database: MEDLINE Main subject: Rural Population / Diabetes Mellitus Type of study: Etiology_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Aspects: Determinantes_sociais_saude Limits: Female / Humans / Male Language: En Journal: Diabetes Care Year: 2022 Document type: Article