OBJECTIVE Diabetes is a rapidly growing health problem in low- and middle-income countries (LMICs), but empirical data on its prevalence and relationship to socioeconomic status are scarce. We estimated diabetes prevalence and the subset with undiagnosed diabetes in 29 LMICs and evaluated the relationship of education, household wealth, and BMI with diabetes risk. RESEARCH DESIGN AND METHODS We pooled individual-level data from 29 nationally representative surveys conducted between 2008 and 2016, totaling 588,574 participants aged ≥25 years. Diabetes prevalence and the subset with undiagnosed diabetes was calculated overall and by country, World Bank income group (WBIG), and geographic region. Multivariable Poisson regression models were used to estimate relative risk (RR). RESULTS Overall, prevalence of diabetes in 29 LMICs was 7.5% (95% CI 7.1-8.0) and of undiagnosed diabetes 4.9% (4.6-5.3). Diabetes prevalence increased with increasing WBIG: countries with low-income economies (LICs) 6.7% (5.5-8.1), lower-middle-income economies (LMIs) 7.1% (6.6-7.6), and upper-middle-income economies (UMIs) 8.2% (7.5-9.0). Compared with no formal education, greater educational attainment was associated with an increased risk of diabetes across WBIGs, after adjusting for BMI (LICs RR 1.47 [95% CI 1.22-1.78], LMIs 1.14 [1.06-1.23], and UMIs 1.28 [1.02-1.61]). CONCLUSIONS Among 29 LMICs, diabetes prevalence was substantial and increased with increasing WBIG. In contrast to the association seen in high-income countries, diabetes risk was highest among those with greater educational attainment, independent of BMI. LMICs included in this analysis may be at an advanced stage in the nutrition transition but with no reversal in the socioeconomic gradient of diabetes risk.

中文翻译：

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29 个低收入和中等收入国家的糖尿病患病率及其与教育、财富和体重指数的关系。


目的 糖尿病是低收入和中等收入国家 (LMIC) 中一个迅速增长的健康问题，但有关其患病率及其与社会经济地位关系的经验数据却很少。我们估计了 29 个中低收入国家的糖尿病患病率和未确诊糖尿病的子集，并评估了教育、家庭财富和体重指数与糖尿病风险的关系。研究设计和方法 我们汇集了 2008 年至 2016 年间进行的 29 项全国代表性调查的个人数据，总计 588,574 名年龄≥25 岁的参与者。糖尿病患病率和未确诊糖尿病的子集是按国家、世界银行收入组 (WBIG) 和地理区域进行总体计算的。使用多变量泊松回归模型来估计相对风险（RR）。结果 总体而言，29 个中低收入国家的糖尿病患病率为 7.5% (95% CI 7.1-8.0)，未确诊糖尿病患病率为 4.9% (4.6-5.3)。糖尿病患病率随着 WBIG 的增加而增加：低收入经济体 (LIC) 6.7% (5.5-8.1)、中低收入经济体 (LMI) 7.1% (6.6-7.6) 和中高收入经济体 (UMIs) ) 8.2% (7.5-9.0)。与没有接受过正规教育相比，在调整 BMI 后，较高的教育程度与 WBIG 的糖尿病风险增加相关（LICs RR 1.47 [95% CI 1.22-1.78]、LMIs 1.14 [1.06-1.23] 和 UMIs 1.28 [1.02] -1.61]）。结论 在 29 个中低收入国家中，糖尿病患病率很高，并且随着 WBIG 的增加而增加。与高收入国家的关联相反，受教育程度较高的人患糖尿病的风险最高，与体重指数无关。本分析中包含的中低收入国家可能处于营养转型的后期阶段，但糖尿病风险的社会经济梯度没有逆转。