Educational differences in diabetes and diabetes self-management behaviours in WHO SAGE countries

Abstract Background Diabetes mellitus represents a substantial global health challenge, with prevalence rising in low- and middle-income countries (LMICs). Although diabetes is known to follow a socioeconomic gradient, patterns in LMICs are unclear. This study examined associations between education...

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Autores principales:	Karen E. Lamb, David Crawford, Lukar E. Thornton, Sheikh M. Shariful Islam, Ralph Maddison, Kylie Ball
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Diabetes mellitus Global Health Developing countries Cohort Adult Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/110420885bc14df480f535ef4abcfe3b
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spelling	oai:doaj.org-article:110420885bc14df480f535ef4abcfe3b2021-11-21T12:10:43ZEducational differences in diabetes and diabetes self-management behaviours in WHO SAGE countries10.1186/s12889-021-12131-71471-2458https://doaj.org/article/110420885bc14df480f535ef4abcfe3b2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12889-021-12131-7https://doaj.org/toc/1471-2458Abstract Background Diabetes mellitus represents a substantial global health challenge, with prevalence rising in low- and middle-income countries (LMICs). Although diabetes is known to follow a socioeconomic gradient, patterns in LMICs are unclear. This study examined associations between education and diabetes, and diabetes self-management behaviours, in six LMICs. Methods Cross-sectional data for 31,780 participants from China, Ghana, India, Mexico, Russia, and South Africa from the World Health Organization Study on Global AGEing and adult health (SAGE) study were used. Participants aged ≥50 years completed face-to-face interviews between 2007 and 2010. Participants self-reported diabetes diagnosis, physical activity, sedentary time, fruit and vegetable consumption, any special diet/program for diabetes, whether they were taking insulin for diabetes and number of years of education. Height, weight, waist, and hip circumference were measured. Country-specific survey-weighted log-binomial regression models were fitted to examine associations between the number of years of education and self-reported diabetes diagnosis (primary analysis). In secondary analyses, among those with a self-reported diabetes diagnosis, generalised linear regression models were fitted to examine associations between education and i) physical activity, ii) sedentary time, iii) fruit and vegetable consumption, iv) special diet for diabetes, v) taking insulin, vi) BMI, vii) waist circumference and viii) hip circumference. Results There was strong evidence of an association between years of education and diabetes diagnosis in Ghana (RR = 1.09, 95% CI: 1.06–1.13) and India (RR = 1.09, 95% CI: 1.07–1.12) only. In India, greater years of education was associated with higher leisure physical activity, fruit and vegetable intake, rates following a special diet or taking insulin, but also higher mean BMI, waist and hip circumference. Relationships between education and self-management behaviours were rarely seen in the other countries. Conclusions Associations between education and diabetes, and behavioural self-management (India only) was more evident in the two least developed (Ghana and India) of the WHO SAGE countries, indicating increasing diabetes diagnosis with greater numbers of years of education. The lack of gradients elsewhere may reflect shifting risk from higher to lower educated populations. While there was some suggestion that self-management behaviours were greater with increased education in India, this was not observed in the other countries.Karen E. LambDavid CrawfordLukar E. ThorntonSheikh M. Shariful IslamRalph MaddisonKylie BallBMCarticleDiabetes mellitusGlobal HealthDeveloping countriesCohortAdultPublic aspects of medicineRA1-1270ENBMC Public Health, Vol 21, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diabetes mellitus Global Health Developing countries Cohort Adult Public aspects of medicine RA1-1270
spellingShingle	Diabetes mellitus Global Health Developing countries Cohort Adult Public aspects of medicine RA1-1270 Karen E. Lamb David Crawford Lukar E. Thornton Sheikh M. Shariful Islam Ralph Maddison Kylie Ball Educational differences in diabetes and diabetes self-management behaviours in WHO SAGE countries
description	Abstract Background Diabetes mellitus represents a substantial global health challenge, with prevalence rising in low- and middle-income countries (LMICs). Although diabetes is known to follow a socioeconomic gradient, patterns in LMICs are unclear. This study examined associations between education and diabetes, and diabetes self-management behaviours, in six LMICs. Methods Cross-sectional data for 31,780 participants from China, Ghana, India, Mexico, Russia, and South Africa from the World Health Organization Study on Global AGEing and adult health (SAGE) study were used. Participants aged ≥50 years completed face-to-face interviews between 2007 and 2010. Participants self-reported diabetes diagnosis, physical activity, sedentary time, fruit and vegetable consumption, any special diet/program for diabetes, whether they were taking insulin for diabetes and number of years of education. Height, weight, waist, and hip circumference were measured. Country-specific survey-weighted log-binomial regression models were fitted to examine associations between the number of years of education and self-reported diabetes diagnosis (primary analysis). In secondary analyses, among those with a self-reported diabetes diagnosis, generalised linear regression models were fitted to examine associations between education and i) physical activity, ii) sedentary time, iii) fruit and vegetable consumption, iv) special diet for diabetes, v) taking insulin, vi) BMI, vii) waist circumference and viii) hip circumference. Results There was strong evidence of an association between years of education and diabetes diagnosis in Ghana (RR = 1.09, 95% CI: 1.06–1.13) and India (RR = 1.09, 95% CI: 1.07–1.12) only. In India, greater years of education was associated with higher leisure physical activity, fruit and vegetable intake, rates following a special diet or taking insulin, but also higher mean BMI, waist and hip circumference. Relationships between education and self-management behaviours were rarely seen in the other countries. Conclusions Associations between education and diabetes, and behavioural self-management (India only) was more evident in the two least developed (Ghana and India) of the WHO SAGE countries, indicating increasing diabetes diagnosis with greater numbers of years of education. The lack of gradients elsewhere may reflect shifting risk from higher to lower educated populations. While there was some suggestion that self-management behaviours were greater with increased education in India, this was not observed in the other countries.
format	article
author	Karen E. Lamb David Crawford Lukar E. Thornton Sheikh M. Shariful Islam Ralph Maddison Kylie Ball
author_facet	Karen E. Lamb David Crawford Lukar E. Thornton Sheikh M. Shariful Islam Ralph Maddison Kylie Ball
author_sort	Karen E. Lamb
title	Educational differences in diabetes and diabetes self-management behaviours in WHO SAGE countries
title_short	Educational differences in diabetes and diabetes self-management behaviours in WHO SAGE countries
title_full	Educational differences in diabetes and diabetes self-management behaviours in WHO SAGE countries
title_fullStr	Educational differences in diabetes and diabetes self-management behaviours in WHO SAGE countries
title_full_unstemmed	Educational differences in diabetes and diabetes self-management behaviours in WHO SAGE countries
title_sort	educational differences in diabetes and diabetes self-management behaviours in who sage countries
publisher	BMC
publishDate	2021
url	https://doaj.org/article/110420885bc14df480f535ef4abcfe3b
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Educational differences in diabetes and diabetes self-management behaviours in WHO SAGE countries

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