PMID- 33542029
OWN - NLM
STAT- MEDLINE
DCOM- 20211021
LR  - 20211119
IS  - 1470-2738 (Electronic)
IS  - 0143-005X (Print)
IS  - 0143-005X (Linking)
VI  - 75
IP  - 9
DP  - 2021 Sep
TI  - Association of education level with diabetes prevalence in Latin American cities 
      and its modification by city social environment.
PG  - 874-880
LID - 10.1136/jech-2020-216116 [doi]
AB  - BACKGROUND: Diabetes 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. METHODS: Using 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. RESULTS: In 
      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. CONCLUSION: Social 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.
CI  - (c) Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published 
      by BMJ.
FAU - Braverman-Bronstein, Ariela
AU  - Braverman-Bronstein A
AUID- ORCID: 0000-0002-9999-808X
AD  - Urban Health Collaborative, Drexel University Dornsife School of Public Health, 
      Philadelphia, PA, USA ab4257@drexel.edu.
FAU - Hessel, Philipp
AU  - Hessel P
AD  - School of Government, Universidad de los Andes, Bogota, Colombia.
FAU - Gonzalez-Uribe, Catalina
AU  - Gonzalez-Uribe C
AD  - School of Medicine, University of Los Andes, Bogota, Colombia.
FAU - Kroker, Maria F
AU  - Kroker MF
AD  - INCAP Research Center for the Prevention of Chronic Diseases, Institute of 
      Nutrition of Central America and Panama, Guatemala City, Guatemala.
FAU - Diez-Canseco, Francisco
AU  - Diez-Canseco F
AD  - CRONICAS, Center of Excellence in Chronic Diseases, University Peruana Cayetano 
      Heredia, Lima, Peru.
FAU - Langellier, Brent
AU  - Langellier B
AD  - Urban Health Collaborative, Drexel University Dornsife School of Public Health, 
      Philadelphia, PA, USA.
FAU - Lucumi, Diego I
AU  - Lucumi DI
AD  - School of Government, Universidad de los Andes, Bogota, Colombia.
FAU - Rodriguez Osiac, Lorena
AU  - Rodriguez Osiac L
AD  - School of Medicine, University of Chile, Santiago, Chile.
FAU - Trotta, Andres
AU  - Trotta A
AUID- ORCID: 0000-0003-4181-1494
AD  - Institute of Collective Health, National University of Lanus, Buenos Aires, 
      Argentina.
FAU - Diez Roux, Ana V
AU  - Diez Roux AV
AD  - Urban Health Collaborative, Drexel University Dornsife School of Public Health, 
      Philadelphia, PA, USA.
LA  - eng
GR  - WT_/Wellcome Trust/United Kingdom
GR  - 205177/WT_/Wellcome Trust/United Kingdom
GR  - 205177/Z/16/Z/WT_/Wellcome Trust/United Kingdom
GR  - P30 DK111022/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210204
PL  - England
TA  - J Epidemiol Community Health
JT  - Journal of epidemiology and community health
JID - 7909766
SB  - IM
MH  - Cities/epidemiology
MH  - *Diabetes Mellitus/epidemiology
MH  - Female
MH  - Humans
MH  - Latin America/epidemiology
MH  - Male
MH  - Prevalence
MH  - *Social Environment
MH  - Socioeconomic Factors
PMC - PMC7611487
MID - EMS131090
OTO - NOTNLM
OT  - diabetes
OT  - education
OT  - epidemiology
OT  - social inequalities
OT  - urbanisation
COIS- Competing interests: None declared.
EDAT- 2021/02/06 06:00
MHDA- 2021/11/20 06:00
PMCR- 2021/08/18
CRDT- 2021/02/05 05:46
PHST- 2020/11/23 00:00 [received]
PHST- 2021/01/14 00:00 [revised]
PHST- 2021/01/23 00:00 [accepted]
PHST- 2021/02/06 06:00 [pubmed]
PHST- 2021/11/20 06:00 [medline]
PHST- 2021/02/05 05:46 [entrez]
PHST- 2021/08/18 00:00 [pmc-release]
AID - jech-2020-216116 [pii]
AID - 10.1136/jech-2020-216116 [doi]
PST - ppublish
SO  - J Epidemiol Community Health. 2021 Sep;75(9):874-880. doi: 
      10.1136/jech-2020-216116. Epub 2021 Feb 4.