Socioeconomic Inequalities of Undiagnosed Diabetes in a Resource-Poor Setting: Insights from the Cross-Sectional Bangladesh Demographic and Health Survey 2011.

Md Mehedi Hasan,Sayem Ahmed,Fariha Tasnim,Md Tariqujjaman

doi:10.3390/ijerph16010115

Abstract

Diabetes mellitus is rising disproportionately but is not frequently diagnosed until complications appear, which results in adverse health consequences. We estimated the prevalence of undiagnosed diabetes among adult diabetic patients and associated socioeconomic inequalities in Bangladesh. We used nationally representative cross-sectional Bangladesh Demographic and Health Survey (BDHS) 2011 data. Among patients with diabetes, we identified undiagnosed cases as having fasting plasma glucose ≥ 7.0 mmol/L, never having taken prescribed medicine and being told by health professionals. Among 938 patients with diabetes, 53.4% remained undiagnosed. The poorest (75.9%) and rural (59.0%) patients had significantly higher undiagnosed cases than the richest (36.0%) and urban (42.5%), respectively. Multiple logistic regression analysis revealed that the likelihood of being undiagnosed was lower among patients with age ≥ 70 years vs. 35–39 years (adjusted odds ratio (AOR) = 0.35; 95% confidence interval (CI) 0.19, 0.64) and patients with higher education vs. no education (AOR = 0.36; 95% CI 0.21, 0.62). Conversely, a high level of physical activity and being in a poor socioeconomic quintile were associated with a higher risk of remaining undiagnosed for diabetes. The Concentration Index (C) also showed that undiagnosed diabetes was largely distributed among the socioeconomically worse-off group in Bangladesh (C = −0.35). Nationwide diabetes screening programs may reduce this problem in Bangladesh and other similar low-income settings.

Highlights

The disproportionate increase in the prevalence of non-communicable diseases (NCDs) has become a major public health shortcoming globally, especially in developing countries [1].Among NCDs, diabetes mellitus is considered one of the major global public health challenges of the twenty-first century [2]
Findings showed that 63% of patients were involved in work that required light physical activity
We found that patient age, education, body mass index (BMI), physical activity, administrative division, place of residence and wealth quintiles were significantly associated with the prevalence of undiagnosed diabetes among adult diabetic patients in unadjusted regression analysis

Summary

Introduction

The disproportionate increase in the prevalence of non-communicable diseases (NCDs) has become a major public health shortcoming globally, especially in developing countries [1]. Among NCDs, diabetes mellitus is considered one of the major global public health challenges of the twenty-first century [2]. 285 million adults were affected by diabetes mellitus in 2010 and it is estimated that 439 million adults will be affected by 2030 [3]. In the South-East Asian region, more than. Res. Public Health 2019, 16, 115; doi:10.3390/ijerph16010115 www.mdpi.com/journal/ijerph

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