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

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 Publisher Pubmed

Flood D^{1, 2, 3} ; Geldsetzer P^{4, 5} ; Agoudavi K⁶ ; Aryal KK⁷ ; Brant LCC^{8, 9} ; Brian G¹⁰ ; Dorobantu M¹¹ ; Farzadfar F¹² ; Gheorghefronea O^{11, 13} ; Gurung MS¹⁴ ; Guwatudde D¹⁵ ; Houehanou C¹⁶ ; Jorgensen JMA¹⁷ ; Kondal D^{18, 19} Show All Authors

Flood D^{1, 2, 3}
Geldsetzer P^{4, 5}
Agoudavi K⁶
Aryal KK⁷
Brant LCC^{8, 9}
Brian G¹⁰
Dorobantu M¹¹
Farzadfar F¹²
Gheorghefronea O^{11, 13}
Gurung MS¹⁴
Guwatudde D¹⁵
Houehanou C¹⁶
Jorgensen JMA¹⁷
Kondal D^{18, 19}
Labadarios D²⁰
Marcus ME²¹
Mayige M²²
Moghimi M¹²
Norov B²³
Perman G²⁴
Quesnelcrooks S²⁵
Rashidi MM¹²
Moghaddam SS²⁶
Seiglie JA²⁷
Bahendeka SK^{28, 29}
Steinbrook E³⁰
Theilmann M³¹
Ware LJ^{32, 33}
Vollmer S²¹
Atun R^{34, 35}
Davies JI^{36, 37, 38}
Ali MK^{39, 40}
Rohloff P^{2, 41}
Mannegoehler J^{42, 43}

Show Affiliations

1. Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, United States
2. Center for Indigenous Health Research, Wuquâ€™ Kawoq, Tecpaan, Guatemala
3. Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
4. Division of Primary Care and Population Health, Stanford University, Stanford, CA, United States
5. Chan Zuckerberg Biohub, San Francisco, CA, United States
6. Togo Ministry of Health, Lome, Togo
7. Public Health Promotion and Development Organization, Kathmandu, Nepal
8. Servico de Cardiologia e Cirurgia Cardiovascular, Hospital das Cliinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
9. Departamento de Cliinica Meedica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
10. The Fred Hollows Foundation New Zealand, Auckland, New Zealand
11. University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
12. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
13. Cardiology Department, Emergency Hospital Bucharest, Bucharest, Romania
14. Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan
15. Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
16. Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
17. Department of Public Health, University of Copenhagen, Copenhagen, Denmark
18. Public Health Foundation of India, Gurugram, India
19. Centre for Chronic Disease Control, New Delhi, India
20. Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
21. Department of Economics and Centre for Modern Indian Studies, University of Gâ‚¬ottingen, Gâ‚¬ottingen, Germany
22. National Institute for Medical Research, Dar es Salaam, Tanzania
23. Division of Nutrition, National Center for Public Health, Ulaanbaatar, Mongolia
24. Department of Public Health, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
25. Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
26. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
27. Diabetes Unit, Massachusetts General Hospital, Boston, MA, United States
28. Saint Francis Hospital Nsambya, Kampala, Uganda
29. Uganda Martyrs University, Kampala, Uganda
30. University of Michigan Medical School, Ann Arbor, MI, United States
31. Heidelberg Institute of Global Health, Heidelberg University and University Hospital, Heidelberg, Germany
32. South African Medical Research Councilâ€“Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
33. Department of Science and Innovationâ€“National Research Foundation Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
34. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
35. Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, United States
36. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
37. Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
38. Medical Research Council/Wits University, Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
39. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
40. Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, United States
41. Division of Global Health Equity, Brigham and Womenâ€™s Hospital, Boston, MA, United States
42. Division of Infectious Diseases, Brigham and Womenâ€™s Hospital, Harvard Medical School, Boston, MA, United States
43. Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States

Source: Diabetes Care Published:2022

Abstract

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 25 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. © 2022 by the American Diabetes Association.

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Style	Citing Format
MLA	Flood D, et al.. "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." Diabetes Care, vol. 45, no. 9, 2022, pp. 1961-1970.
APA	Flood D, Geldsetzer P, Agoudavi K, Aryal KK, Brant LCC, Brian G, Dorobantu M, Farzadfar F, Gheorghefronea O, Gurung MS, Guwatudde D, Houehanou C, Jorgensen JMA, Kondal D, Labadarios D, Marcus ME, Mayige M, Moghimi M, Norov B, ... Mannegoehler J (2022). 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. Diabetes Care, 45(9), 1961-1970.
Chicago	Flood D, Geldsetzer P, Agoudavi K, Aryal KK, Brant LCC, Brian G, Dorobantu M, et al.. "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." Diabetes Care 45, no. 9 (2022): 1961-1970.
Harvard	Flood D et al. (2022) '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', Diabetes Care, 45(9), pp. 1961-1970.
Vancouver	Flood D, Geldsetzer P, Agoudavi K, Aryal KK, Brant LCC, Brian G, et al.. 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. Diabetes Care. 2022;45(9):1961-1970.
BibTex	@article{ author = {Flood D and Geldsetzer P and Agoudavi K and Aryal KK and Brant LCC and Brian G and Dorobantu M and Farzadfar F and Gheorghefronea O and Gurung MS and Guwatudde D and Houehanou C and Jorgensen JMA and Kondal D and Labadarios D and Marcus ME and Mayige M and Moghimi M and Norov B and Perman G and Quesnelcrooks S and Rashidi MM and Moghaddam SS and Seiglie JA and Bahendeka SK and Steinbrook E and Theilmann M and Ware LJ and Vollmer S and Atun R and Davies JI and Ali MK and Rohloff P and Mannegoehler J}, title = {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}, journal = {Diabetes Care}, volume = {45}, number = {9}, pages = {1961-1970}, year = {2022} }
RIS	TY - JOUR AU - Flood D AU - Geldsetzer P AU - Agoudavi K AU - Aryal KK AU - Brant LCC AU - Brian G AU - Dorobantu M AU - Farzadfar F AU - Gheorghefronea O AU - Gurung MS AU - Guwatudde D AU - Houehanou C AU - Jorgensen JMA AU - Kondal D AU - Labadarios D AU - Marcus ME AU - Mayige M AU - Moghimi M AU - Norov B AU - Perman G AU - Quesnelcrooks S AU - Rashidi MM AU - Moghaddam SS AU - Seiglie JA AU - Bahendeka SK AU - Steinbrook E AU - Theilmann M AU - Ware LJ AU - Vollmer S AU - Atun R AU - Davies JI AU - Ali MK AU - Rohloff P AU - Mannegoehler J TI - 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 JO - Diabetes Care VL - 45 IS - 9 SP - 1961 EP - 1970 PY - 2022 ER -

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