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

Journal article

David Flood, Geldsetzer P, Agoudavi K, Aryal KK, Campos Caldeira Brant L, Brian G, Dorobantu M, Farzadfar F, Fronea O, Singh Gurung M, Guwatudde D, Houehanou C, Jorgensen J, Kondal D, Labadarios D, Marcus ME, Mayige MT, Moghimi M, Norov B, Perman G, Quesnel-Crooks S, Rashidi MM, Moghaddam SS, Seiglie JA, Bahendeka S, Steinbrook E, Theilmann M, Ware LJ, Vollmer S, Atun R, Davies J, Ali MK, Rohloff P, Manne-Goehler J
Diabetes Care, vol. 45(9), 2022, pp. 1961–1970

DOI: 10.2337/dc21-2342

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APA Click to copy
Flood, D., P, G., K, A., KK, A., L, C. C. B., G, B., … J, M.-G. (2022). 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. Diabetes Care, 45(9), 1961–1970. https://doi.org/10.2337/dc21-2342

Chicago/Turabian Click to copy
Flood, David, Geldsetzer P, Agoudavi K, Aryal KK, Campos Caldeira Brant L, Brian G, Dorobantu M, et al. “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.” Diabetes Care 45, no. 9 (2022): 1961–1970.

MLA Click to copy
Flood, David, et al. “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.” Diabetes Care, vol. 45, no. 9, 2022, pp. 1961–70, doi:10.2337/dc21-2342 .

BibTeX Click to copy

@article{david2022a,
  title = {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},
  year = {2022},
  issue = {9},
  journal = {Diabetes Care},
  pages = {1961–1970},
  volume = {45},
  doi = {10.2337/dc21-2342 },
  author = {Flood, David and P, Geldsetzer and K, Agoudavi and KK, Aryal and L, Campos Caldeira Brant and G, Brian and M, Dorobantu and F, Farzadfar and O, Fronea and M, Singh Gurung and D, Guwatudde and C, Houehanou and J, Jorgensen and D, Kondal and D, Labadarios and ME, Marcus and MT, Mayige and M, Moghimi and B, Norov and G, Perman and S, Quesnel-Crooks and MM, Rashidi and SS, Moghaddam and JA, Seiglie and S, Bahendeka and E, Steinbrook and M, Theilmann and LJ, Ware and S, Vollmer and R, Atun and J, Davies and MK, Ali and P, Rohloff and J, Manne-Goehler}
}

Abstract

Objective: 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 −5 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.