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Journal article
Association of education level with diabetes prevalence in Latin American cities and its modification by city social environment
Journal of epidemiology and community health (1979), v 75(9), pp 874-880
Sep 2021
PMID: 33542029
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BackgroundDiabetes prevalence continues to increase in urban areas of low-income and middle-income countries (LMIC). Evidence from high-income countries suggests an inverse association between educational attainment and diabetes, but research in LMIC is limited. We investigated educational differences in diabetes prevalence across 232 Latin American (LA) cities, and the extent to which these inequities vary across countries/cities and are modified by city socioeconomic factors.MethodsUsing harmonised health survey and census data for 110 498 city dwellers from eight LA countries, we estimated the association between education and diabetes. We considered effect modification by city Social Environment Index (SEI) as a proxy for city-level development using multilevel models, considering heterogeneity by sex and country.ResultsIn women, there was an inverse dose–response relationship between education and diabetes (OR: 0.80 per level increase in education, 95% CI 0.75 to 0.85), consistent across countries and not modified by SEI. In men, Argentina, Brazil, Colombia, Chile and Mexico showed an inverse association (pooled OR: 0.92; 95% CI 0.86 to 0.99). Peru, Panama and El Salvador showed a positive relationship (pooled OR 1.24; 95% CI 1.04 to 1.49). For men, these associations were further modified by city-SEI: in countries with an inverse association, it became stronger as city-SEI increased. In countries where the association was positive, it became weaker as city-SEI increased.ConclusionSocial inequities in diabetes inequalities increase as cities develop. To achieve non-communicable disease-related sustainable development goals in LMIC, there is an urgent need to develop policies aimed at reducing these educational inequities.
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Details
- Title
- Association of education level with diabetes prevalence in Latin American cities and its modification by city social environment
- Creators
- Ariela Braverman-Bronstein - Drexel UniversityPhilipp Hessel - Universidad de Los AndesCatalina González-Uribe - Universidad de Los AndesMaria F Kroker - Institute of Nutrition of Central America and PanamaFrancisco Diez-Canseco - Cayetano Heredia UniversityBrent Langellier - Drexel UniversityDiego I Lucumi - Universidad de Los AndesLorena Rodríguez Osiac - School of Medicine, University of Chile, Santiago, ChileAndrés Trotta - National University of LanúsAna V Diez Roux - Drexel University
- Publication Details
- Journal of epidemiology and community health (1979), v 75(9), pp 874-880
- Publisher
- British Medical Journal (BMJ)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Urban Health Collaborative; Health Management and Policy
- Web of Science ID
- WOS:000753960800011
- Scopus ID
- 2-s2.0-85103960104
- Other Identifier
- 991019168023504721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Public, Environmental & Occupational Health