Assessment of the magnitude of contextual and individual demographic effects on diabetes mellitus and glucose intolerance in rural Southwest China: a multilevel analysis.

Ke-Wei Wang,Le Cai,Zhan-Kun Shu,Jun-Qing Wu,Wei Wei,Yan Gong

doi:10.1371/journal.pone.0068553

Abstract

ObjectiveThis study aimed to determine the contribution of individual and contextual socioeconomic status (SES) to the prevalence of diabetes mellitus and glucose intolerance in the adult population in rural southwest China.MethodsA population-based cross-sectional study of diabetes was performed in 4801(2152 men) Chinese adults (≥25 years old). Multilevel logistic regression model was used to examine the association between individuals’ and townships’ variables and the prevalence of diabetes mellitus and glucose intolerance.ResultsThe age-and gender-standardized prevalence of diabetes mellitus and glucose intolerance were 7.1% (3.6% for undiagnosed) and 8.8% in adults aged ≥25 years, respectively, and increasing with age. Females were more likely to develop diabetes than males. The probability of developing diabetes increased with BMI. Both contextual and individual educational level and yearly household income were found to be negatively associated with the prevalence of diabetes. Residence in communities with a higher percentage of ethnic minorities was associated with higher prevalence of diabetes. Smoking had a protective effect for diabetes, drinking had a positive association with diabetes mellitus and glucose intolerance.ConclusionsDiabetes mellitus and glucose intolerance are common in rural adults of southwest China by international standards. These results indicate that diabetes mellitus has become a major public health problem in rural areas in southwest China, and strategies aimed at the prevention and treatment of diabetes mellitus and glucose intolerance are needed.

Highlights

In the past two decades there has been an overall increase of diabetes mellitus prevalence in the developing countries [1,2,3]
Most recent estimates of diabetes mellitus prevalence in China have relied on self-reported data, but since Type 2 diabetes can be asymptomatic for many years before it is diagnosed in a clinical situation, reliance on selfreported information invariably contributes to an underestimation of the true prevalence
The data were further analyzed by means of a multilevel logistic regression model, whose estimation was performed by restricted maximum likelihood, with individual characteristics at the first level and contextual socioeconomic status at the second

Summary

Introduction

In the past two decades there has been an overall increase of diabetes mellitus prevalence in the developing countries [1,2,3]. Few have studies examined the relative contributions of contextual risk factors to the increased prevalence of diabetes mellitus in the Chinese population, especially among rural populations. Most recent estimates of diabetes mellitus prevalence in China have relied on self-reported data, but since Type 2 diabetes can be asymptomatic for many years before it is diagnosed in a clinical situation, reliance on selfreported information invariably contributes to an underestimation of the true prevalence. Such studies failed to provide information on contextual socioeconomic determinants, which are able to substantially increase the risk of future diabetes mellitus

Methods

Results

Conclusion