The escalating diabetes epidemic: determinants of prevalence disparity between country income groups

Abstract

Rationale: Nowadays, diabetes mellitus is continuing to be an increasing international health burden. But greatest increases of this burden are seen particularly in low- and middle-income countries. This thesis attempts to account for the factors associated with the increasing prevalence of diabetes and the disparity in this prevalence across country income groups. Method: An analytic ecological study was performed using 183 WHO Member States grouped into low-, lower middle-, upper middle- and high-income countries. Linear regression analyses were used to determine possible associations between diabetes mellitus prevalence and health expenditure for diabetes plus other health indicators (that is, life expectancy at birth, prevalence of tuberculosis, population living in urban areas, out-of-pocket health expenditure, adults aged ≥ 20 years who are obese, alcohol consumption among adult aged ≥ 15 years), both in the 183 WHO Member States and within each WHO country income group. Results: The prevalence of diabetes mellitus is associated with health expenditure for diabetes, life expectancy, tuberculosis prevalence, urban population, out-of-pocket expenditure, adults aged ≥ 20 years who are obese, and alcohol consumption among adults ≥ 15 years. The association between diabetes mellitus and these factors vary depending on the different country income groups. Conclusion: These findings suggest that since diabetes mellitus prevalence is associated with several factors which vary according to country income groups, strategies for diabetes prevention should not only be person-centered but also income group-specific.