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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| Format: | Article |
| Language: | English |
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BMC
2021-11-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-021-12131-7 |
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| 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 |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-12-13T16:47:06Z |
| format | Article |
| id | doaj.art-110420885bc14df480f535ef4abcfe3b |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-13T16:47:06Z |
| publishDate | 2021-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-110420885bc14df480f535ef4abcfe3b2022-12-21T23:38:08ZengBMCBMC Public Health1471-24582021-11-0121111210.1186/s12889-021-12131-7Educational differences in diabetes and diabetes self-management behaviours in WHO SAGE countriesKaren E. Lamb0David Crawford1Lukar E. Thornton2Sheikh M. Shariful Islam3Ralph Maddison4Kylie Ball5Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition SciencesDeakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition SciencesDeakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition SciencesDeakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition SciencesDeakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition SciencesDeakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition SciencesAbstract 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.https://doi.org/10.1186/s12889-021-12131-7Diabetes mellitusGlobal HealthDeveloping countriesCohortAdult |
| spellingShingle | 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 BMC Public Health Diabetes mellitus Global Health Developing countries Cohort Adult |
| title | 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_short | 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 |
| topic | Diabetes mellitus Global Health Developing countries Cohort Adult |
| url | https://doi.org/10.1186/s12889-021-12131-7 |
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