Multilevel examination of diabetes in modernising China: what elements of urbanisation are most associated with diabetes?

Aims/hypothesis The purpose of this study was to examine the association between urbanisation-related factors and diabetes prevalence in China. Methods Anthropometry, fasting blood glucose (FBG) and community-level data were collected for 7,741 adults (18–90 years) across 217 communities and nine pr...

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Published in:	Diabetologia 2012-12, Vol.55 (12), p.3182-3192
Main Authors:	Attard, S. M., Herring, A. H., Mayer-Davis, E. J., Popkin, B. M., Meigs, J. B., Gordon-Larsen, P.
Format:	Article
Language:	eng
Subjects:	Adolescent Adult Aged Aged, 80 and over Biological and medical sciences Blood Glucose - metabolism Body Mass Index China - epidemiology Diabetes Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - epidemiology Diabetes Mellitus, Type 2 - prevention & control Diabetes. Impaired glucose tolerance Educational Status Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Family income Fasting Female Glycated Hemoglobin A - metabolism Health Surveys Households Human Physiology Humans Infrastructure Internal Medicine Male Medical sciences Medicine Medicine & Public Health Metabolic Diseases Middle Aged Nutrition Nutritional Status Prevalence Provinces Public Health Rural areas Sex Distribution Socioeconomic Factors Surveys and Questionnaires Urban areas Urban Population - statistics & numerical data Urbanization
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Summary:	Aims/hypothesis The purpose of this study was to examine the association between urbanisation-related factors and diabetes prevalence in China. Methods Anthropometry, fasting blood glucose (FBG) and community-level data were collected for 7,741 adults (18–90 years) across 217 communities and nine provinces in the 2009 China Health and Nutrition Survey to examine diabetes (FBG ≥7.0 mmol/l or doctor diagnosis). Sex-stratified multilevel models, clustered at the community and province levels and controlling for individual-level age and household income were used to examine the association between diabetes and: (1) a multicomponent urbanisation measure reflecting overall modernisation and (2) 12 separate components of urbanisation (e.g., population density, employment, markets, infrastructure and social factors). Results Prevalent diabetes was higher in more-urbanised (men 12%; women 9%) vs less-urbanised (men 6%; women 5%) areas. In sex-stratified multilevel models adjusting for residential community and province, age and household income, there was a twofold higher diabetes prevalence in urban vs rural areas (men OR 2.02, 95% CI 1.47, 2.78; women, OR 1.94, 95% CI 1.35, 2.79). All urbanisation components were positively associated with diabetes, with variation across components (e.g. men, economic and income diversity, OR 1.42, 95% CI 1.20, 1.66; women, transportation infrastructure, OR 1.18, 95% CI 1.06, 1.32). Community-level variation in diabetes was comparatively greater for women (intraclass correlation [ICC] 0.03–0.05) vs men (ICC ≤0.01); province-level variation was greater for men (men 0.03–0.04; women 0.02). Conclusions/interpretation Diabetes prevention and treatment efforts are needed particularly in urbanised areas of China. Community economic factors, modern markets, communications and transportation infrastructure might present opportunities for such efforts.
ISSN:	0012-186X 1432-0428