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.

中文翻译：

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42 个中低收入国家糖尿病护理和控制的城乡差异：具有全国代表性的个人水平数据的横断面研究

目标 低收入和中等收入国家 (LMIC) 农村地区的糖尿病患病率正在迅速增加，但关于卫生系统在为农村人口提供公平和有效护理方面表现的数据有限。因此，我们评估了中低收入国家糖尿病护理和控制的城乡差异。研究设计和方法 我们汇总了来自 42 个国家的具有全国代表性的健康调查的个人数据。我们使用泊松回归模型来估计农村与城市地区糖尿病患者在诊断、治疗和控制糖尿病及相关心血管危险因素方面的绩效指标的年龄调整差异。我们检查了汇总样本、性别和国家/地区的差异。结果 来自 42 个国家的汇总样本包括 840 个，110 人（35,404 人患有糖尿病）。与患有糖尿病的城市人口相比，农村人口实现糖尿病诊断和治疗绩效指标的相对风险降低了 15-30%。被诊断为糖尿病的农村人口的血糖控制相对风险降低了 14% (95% CI 5–22%)，血压控制的相对风险降低了 6% (95% CI -5 到 16%)，以及 23% (95 % CI 2–39%) 降低胆固醇控制的相对风险。与城市女性相比，患有糖尿病的农村女性在与控制相关的绩效指标方面的成就较低，而在男性中，差异很小。结论 患有糖尿病的农村人口在中低收入国家的糖尿病表现测量中经历了巨大的不公平。