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

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dc.contributor.authorDavid Flood
dc.contributor.authorPascal Geldsetzer
dc.contributor.authorKokou Agoudavi
dc.contributor.authorKrishna K. Aryal
dc.contributor.authorLuisa Campos Caldeira Brant
dc.contributor.authorGarry Brian
dc.contributor.authorMaria Dorobantu
dc.contributor.authorFarshad Farzadfar
dc.contributor.authorOana Gheorghe-Fronea
dc.contributor.authorMongal Singh Gurung
dc.contributor.authorDavid Guwatudde
dc.contributor.authorCorine Houehanou
dc.contributor.authorJutta M. Adelin Jorgensen
dc.contributor.authorDimple Kondal
dc.contributor.authorDemetre Labadarios
dc.contributor.authorMaja E. Marcus
dc.contributor.authorMary Mayige
dc.contributor.authorMana Moghimi
dc.contributor.authorBolormaa Norov
dc.contributor.authorGaston Perman
dc.contributor.authorSarah Quesnel-Crooks
dc.contributor.authorMohammad-Mahdi Rashidi
dc.contributor.authorSahar Saeedi Moghaddam
dc.contributor.authorJacqueline A. Seiglie
dc.contributor.authorSilver K. Bahendeka
dc.contributor.authorEric Steinbrook
dc.contributor.authorMichaela Theilmann
dc.contributor.authorLisa J. Ware
dc.contributor.authorSebastian Vollmer
dc.contributor.authorRifat Atun
dc.contributor.authorJustine I. Davies
dc.contributor.authorMohammed K. Ali
dc.contributor.authorPeter Rohloff
dc.contributor.authorJennifer Manne-Goehler
dc.date.accessioned2024-04-01T17:24:11Z
dc.date.available2024-04-01T17:24:11Z
dc.date.issued2022-09
dc.description.abstractOBJECTIVE 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.
dc.description.librarianPM2023
dc.facultyFaculty of Health Sciences
dc.identifier.urihttps://hdl.handle.net/10539/38249
dc.language.isoen
dc.schoolPublic Health
dc.titleRural-Urban Differences in Diabetes Care and Control in 42 Low- and Middle-Income Countries: A Cross-sectional Study of Nationally Representative Individual-Level Data
dc.typeArticle
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