Health disparities and inequalities in prevalence of diabetes in the Kingdom of Saudi Arabia.
Concentration curve
Concentration index
Diabetes
Diabetes prevalence
Inequalities
Saudi Arabia
Socio-economic status
Journal
International journal for equity in health
ISSN: 1475-9276
Titre abrégé: Int J Equity Health
Pays: England
ID NLM: 101147692
Informations de publication
Date de publication:
18 Sep 2024
18 Sep 2024
Historique:
received:
21
06
2024
accepted:
27
08
2024
medline:
19
9
2024
pubmed:
19
9
2024
entrez:
18
9
2024
Statut:
epublish
Résumé
Over time, global health systems have witnessed significant improvements in the delivery and coverage of healthcare services. Nevertheless, the increasing prominence of non-communicable diseases remains a persistent challenge. Diabetes is one such non-communicable chronic disease that poses a threat with respect to both mortality and morbidity. This study investigated the socio-economic determinants and inequalities in the prevalence of diabetes in the Kingdom of Saudi Arabia according to data collected from the 2018 Saudi Family Health Survey conducted by the General Authority for Statistics. The analysis was limited to a sample of 11,528 respondents aged ≥ 18 years, selected across all 13 regions of Saudi Arabia, with complete responses for all variables of interest. Socio-economic determinants in diabetes prevalence were explored with univariate, bivariate, and multivariate logistic regression analyses. Furthermore, inequalities were visualised and quantitatively estimated according to construction of a concentration curve and calculation of the concentration index. The prevalence of diabetes among the 11,528 respondents was 11.20%. Age, education, income, and residence area were significant determinants of diabetes prevalence, with a greater risk of diabetes found in older participants (odds ratio [OR]: 12.262, 95% confidence interval [CI]: 9.820-15.313, p < 0.01) compared to younger participants. Inequality analysis showed a negative education-based concentration index (-0.235, p < 0.01), indicating that diabetes prevalence is concentrated among people with relatively less formal education. For males, the income-based concentration index was significantly positive, whereas the education-based concentration index was significantly negative, indicating a greater concentration of diabetes among Saudi men with higher incomes and less education. These findings emphasize the need to prioritize policies and strategies for diabetes prevention and control with considerations of the socio-economic inequalities in prevalence. Key areas of focus should include improving education levels across all regions, raising awareness about diabetes and implementing nutritional interventions.
Sections du résumé
BACKGROUND
BACKGROUND
Over time, global health systems have witnessed significant improvements in the delivery and coverage of healthcare services. Nevertheless, the increasing prominence of non-communicable diseases remains a persistent challenge. Diabetes is one such non-communicable chronic disease that poses a threat with respect to both mortality and morbidity. This study investigated the socio-economic determinants and inequalities in the prevalence of diabetes in the Kingdom of Saudi Arabia according to data collected from the 2018 Saudi Family Health Survey conducted by the General Authority for Statistics.
METHODS
METHODS
The analysis was limited to a sample of 11,528 respondents aged ≥ 18 years, selected across all 13 regions of Saudi Arabia, with complete responses for all variables of interest. Socio-economic determinants in diabetes prevalence were explored with univariate, bivariate, and multivariate logistic regression analyses. Furthermore, inequalities were visualised and quantitatively estimated according to construction of a concentration curve and calculation of the concentration index.
RESULTS
RESULTS
The prevalence of diabetes among the 11,528 respondents was 11.20%. Age, education, income, and residence area were significant determinants of diabetes prevalence, with a greater risk of diabetes found in older participants (odds ratio [OR]: 12.262, 95% confidence interval [CI]: 9.820-15.313, p < 0.01) compared to younger participants. Inequality analysis showed a negative education-based concentration index (-0.235, p < 0.01), indicating that diabetes prevalence is concentrated among people with relatively less formal education. For males, the income-based concentration index was significantly positive, whereas the education-based concentration index was significantly negative, indicating a greater concentration of diabetes among Saudi men with higher incomes and less education.
CONCLUSION
CONCLUSIONS
These findings emphasize the need to prioritize policies and strategies for diabetes prevention and control with considerations of the socio-economic inequalities in prevalence. Key areas of focus should include improving education levels across all regions, raising awareness about diabetes and implementing nutritional interventions.
Identifiants
pubmed: 39294644
doi: 10.1186/s12939-024-02265-6
pii: 10.1186/s12939-024-02265-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
186Informations de copyright
© 2024. The Author(s).
Références
Heller O, Somerville C, Suggs LS, Lachat S, Piper J, Aya Pastrana N, et al. The process of prioritization of non-communicable diseases in the global health policy arena. Health Policy Plann. 2019;34(5):370–83.
doi: 10.1093/heapol/czz043
Ogurtsova K, da Rocha Fernandes J, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF Diabetes Atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017;128:40–50.
pubmed: 28437734
doi: 10.1016/j.diabres.2017.03.024
Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas. Diabetes Res Clin Pract. 2019;157:107843.
pubmed: 31518657
doi: 10.1016/j.diabres.2019.107843
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4–14.
pubmed: 19896746
doi: 10.1016/j.diabres.2009.10.007
Wang Z, Li X, Chen M. Socioeconomic factors and inequality in the prevalence and treatment of diabetes among middle-aged and elderly adults in China. Journal of diabetes research. 2018;2018.
Hunt KJ, Schuller KL. The increasing prevalence of diabetes in pregnancy. Obstet Gynecol Clin N Am. 2007;34(2):173–99.
doi: 10.1016/j.ogc.2007.03.002
Flor LS, Campos MR. The prevalence of diabetes mellitus and its associated factors in the Brazilian adult population: evidence from a population-based survey. Revista Brasileira De Epidemiologia. 2017;20:16–29.
pubmed: 28513791
doi: 10.1590/1980-5497201700010002
Moradpour F, Rezaei S, Piroozi B, Moradi G, Moradi Y, Piri N, et al. Prevalence of prediabetes, diabetes, diabetes awareness, treatment, and its socioeconomic inequality in west of Iran. Sci Rep. 2022;12(1):17892.
pubmed: 36284227
pmcid: 9596718
doi: 10.1038/s41598-022-22779-9
De Silva AP, De Silva SHP, Haniffa R, Liyanage IK, Jayasinghe KSA, Katulanda P, et al. A survey on socioeconomic determinants of diabetes mellitus management in a lower middle income setting. Int J Equity Health. 2016;15:1–11.
doi: 10.1186/s12939-016-0363-3
Biswas T, Islam MS, Linton N, Rawal LB. Socio-economic inequality of chronic non-communicable diseases in Bangladesh. PLoS ONE. 2016;11(11):e0167140.
pubmed: 27902760
pmcid: 5130253
doi: 10.1371/journal.pone.0167140
Richards SE, Wijeweera C, Wijeweera A. Lifestyle and socioeconomic determinants of diabetes: evidence from country-level data. PLoS ONE. 2022;17(7):e0270476.
pubmed: 35901054
pmcid: 9333224
doi: 10.1371/journal.pone.0270476
Tapager I, Bender AM, Andersen I. A decade of socioeconomic inequality in type 2 diabetes area-level prevalence: an unshakeable status quo? Scand J Public Health. 2023;51(2):268–74.
pubmed: 34986685
doi: 10.1177/14034948211062308
Sarker AR, Khanam M. Socio-economic inequalities in diabetes and prediabetes among Bangladeshi adults. Diabetol Int. 2022;13(2):421–35.
pubmed: 35463862
doi: 10.1007/s13340-021-00556-9
Perseh L, Peimani M, Ghasemi E, Nasli-Esfahani E, Rezaei N, Farzadfar F, et al. Inequalities in the prevalence, diagnosis awareness, treatment coverage and effective control of diabetes: a small area estimation analysis in Iran. BMC Endocr Disorders. 2023;23(1):17.
doi: 10.1186/s12902-023-01271-z
Maiti S, Akhtar S, Upadhyay AK, Mohanty SK. Socioeconomic inequality in awareness, treatment and control of diabetes among adults in India: evidence from National Family Health Survey of India (NFHS), 2019–2021. Sci Rep. 2023;13(1):2971.
pubmed: 36805018
pmcid: 9941485
doi: 10.1038/s41598-023-29978-y
Sidahmed S, Geyer S, Beller J. Socioeconomic inequalities in diabetes prevalence: the case of South Africa between 2003 and 2016. BMC Public Health. 2023;23(1):324.
pubmed: 36788553
pmcid: 9926686
doi: 10.1186/s12889-023-15186-w
Rojas-Roque C, Hernández-Vásquez A, Azañedo D, Bendezu-Quispe G. Socioeconomic inequalities in the prevalence of diabetes in Argentina: a repeated cross-sectional study in Urban women and men. Int J Environ Res Public Health. 2022;19(15):8888.
pubmed: 35897259
pmcid: 9331888
doi: 10.3390/ijerph19158888
Wang J, Wild SH. Marked and widening socioeconomic inequalities in type 2 diabetes prevalence in Scotland. J Epidemiol Community Health. 2022;76(5):482–4.
doi: 10.1136/jech-2021-217747
Al-Hanawi MK, Alsharqi O, Almazrou S, Vaidya K. Healthcare finance in the Kingdom of Saudi Arabia: a qualitative study of householders’ attitudes. Appl Health Econ Health Policy. 2018;16:55–64.
pubmed: 28933057
doi: 10.1007/s40258-017-0353-7
Al-Hanawi MK, Mwale ML, Qattan AM. Health insurance and out-of-pocket expenditure on health and medicine: heterogeneities along income. Front Pharmacol. 2021;12:638035.
pubmed: 33995042
pmcid: 8120147
doi: 10.3389/fphar.2021.638035
Alkhamis AA. The association between insured male expatriates’ knowledge of health insurance benefits and lack of access to health care in Saudi Arabia. BMC Public Health. 2018;18:1–9.
doi: 10.1186/s12889-018-5293-0
Al-Hanawi MK, Alsharqi O, Vaidya K. Willingness to pay for improved public health care services in Saudi Arabia: a contingent valuation study among heads of Saudi households. Health Econ Policy Law. 2020;15(1):72–93.
pubmed: 29862936
doi: 10.1017/S1744133118000191
Alzeidan R, Rabiee F, Mandil A, Hersi A, Fayed A. Non-communicable disease risk factors among employees and their families of a Saudi university: an epidemiological study. PLoS ONE. 2016;11(11):e0165036.
pubmed: 27814369
pmcid: 5096675
doi: 10.1371/journal.pone.0165036
Al-Hanawi MK, Keetile M. Socio-economic and demographic correlates of non-communicable disease risk factors among adults in Saudi Arabia. Front Med. 2021;8:605912.
doi: 10.3389/fmed.2021.605912
Algabbani A, Alqahtani A, BinDhim N. Prevalence and determinants of non-communicable diseases in Saudi Arabia. Food Drug Regul Sci J. 2019;2(2):1.
Mandil AM, Alfurayh NA, Aljebreen MA, Aldukhi SA. Physical activity and major non-communicable diseases among physicians in Central Saudi Arabia. Saudi Med J. 2016;37(11):1243.
pubmed: 27761564
pmcid: 5303803
doi: 10.15537/smj.2016.11.16268
Al-Hanawi MK, Chirwa GC, Pulok MH. Socio-economic inequalities in diabetes prevalence in the Kingdom of Saudi Arabia. Int J Health Plann Manag. 2020;35(1):233–46.
doi: 10.1002/hpm.2899
GASTAT. The General Authority for Statistics: Family Health Survey. 2018 [cited 2021 21 Jan]; https://www.stats.gov.sa/en/965
Al-Saeed AH, Constantino MI, Molyneaux L, D’Souza M, Limacher-Gisler F, Luo C, et al. An inverse relationship between age of type 2 diabetes onset and complication risk and mortality: the impact of youth-onset type 2 diabetes. Diabetes Care. 2016;39(5):823–9.
pubmed: 27006511
doi: 10.2337/dc15-0991
Zou W, Ni L, Lu Q, Zou C, Zhao M, Xu X, et al. Diabetes onset at 31–45 years of age is associated with an increased risk of diabetic retinopathy in type 2 diabetes. Sci Rep. 2016;6(1):38113.
pubmed: 27897261
pmcid: 5126680
doi: 10.1038/srep38113
Wagstaff A, Paci P, Van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med. 1991;33(5):545–57.
pubmed: 1962226
doi: 10.1016/0277-9536(91)90212-U
Qattan AM, Boachie MK, Immurana M, Al-Hanawi MK. Socioeconomic determinants of smoking in the Kingdom of Saudi Arabia. Int J Environ Res Public Health. 2021;18(11):5665.
pubmed: 34070653
pmcid: 8198681
doi: 10.3390/ijerph18115665
Pande RP, Yazbeck AS. What’s in a country average? Wealth, gender, and regional inequalities in immunization in India. Soc Sci Med. 2003;57(11):2075–88.
pubmed: 14512239
doi: 10.1016/S0277-9536(03)00085-6
Thomson KH, Renneberg A-C, McNamara CL, Akhter N, Reibling N, Bambra C. Regional inequalities in self-reported conditions and non-communicable diseases in European countries: findings from the European Social Survey (2014) special module on the social determinants of health. Eur J Public Health. 2017;27(suppl1):14–21.
pubmed: 28355643
doi: 10.1093/eurpub/ckw227
O’Donnell O, Van Doorslaer E, Wagstaff A, Lindelow M. Analyzing health equity using household survey data: a guide to techniques and their implementation. World Bank; 2007.
Ayah R, Joshi MD, Wanjiru R, Njau EK, Otieno CF, Njeru EK, et al. A population-based survey of prevalence of diabetes and correlates in an urban slum community in Nairobi, Kenya. BMC Public Health. 2013;13(1):1–11.
doi: 10.1186/1471-2458-13-371
Gatimu SM, Milimo BW, Sebastian MS. Prevalence and determinants of diabetes among older adults in Ghana. BMC Public Health. 2016;16(1):1–12.
doi: 10.1186/s12889-016-3845-8
Balanda KP, Buckley CM, Barron SJ, Fahy LE, Madden JM, Harrington JM, et al. Prevalence of diabetes in the Republic of Ireland: results from the National Health Survey (SLAN) 2007. PLoS ONE. 2013;8(10):e78406.
pubmed: 24147134
pmcid: 3797781
doi: 10.1371/journal.pone.0078406
Haseen F, Adhikari R, Soonthorndhada K. Self-assessed health among Thai elderly. BMC Geriatr. 2010;10(1):1–9.
doi: 10.1186/1471-2318-10-30
Vandenheede H, Deboosere P, Espelt A, Bopp M, Borrell C, Costa G, et al. Educational inequalities in diabetes mortality across Europe in the 2000s: the interaction with gender. Int J Public Health. 2015;60(4):401–10.
pubmed: 25746676
doi: 10.1007/s00038-015-0669-8
Bihan H, Laurent S, Sass C, Nguyen G, Huot C, Moulin JJ, et al. Association among individual deprivation, glycemic control, and diabetes complications: the EPICES score. Diabetes Care. 2005;28(11):2680–5.
pubmed: 16249539
doi: 10.2337/diacare.28.11.2680
Asadi-Lari M, Khosravi A, Nedjat S, Mansournia M, Majdzadeh R, Mohammad K, et al. Socioeconomic status and prevalence of self-reported diabetes among adults in Tehran: results from a large population-based cross-sectional study (Urban HEART-2). J Endocrinol Investig. 2016;39:515–22.
doi: 10.1007/s40618-015-0384-6
Addo J, Agyemang C, Aikins Ad G, Beune E, Schulze MB, Danquah I, et al. Association between socioeconomic position and the prevalence of type 2 diabetes in ghanaians in different geographic locations: the RODAM study. J Epidemiol Community Health. 2017;71(7):633–9.
pubmed: 28348205
doi: 10.1136/jech-2016-208322
Shahab JA, Alishan KN. The effect of literacy level on health related-quality of life, self-efficacy and self-management behaviors in diabetic patients. Acta Medica Iranica. 2011;49(3):153–8.
Su R, Cai L, Cui W, He J, You D, Golden A. Multilevel analysis of socioeconomic determinants on diabetes prevalence, awareness, treatment and self-management in ethnic minorities of Yunnan Province, China. Int J Environ Res Public Health. 2016;13(8):751.
pubmed: 27463725
pmcid: 4997437
doi: 10.3390/ijerph13080751
Wardle J, Steptoe A. Socioeconomic differences in attitudes and beliefs about healthy lifestyles. J Epidemiol Community Health. 2003;57(6):440–3.
pubmed: 12775791
pmcid: 1732468
doi: 10.1136/jech.57.6.440
Hale NL, Bennett KJ, Probst JC. Diabetes care and outcomes: disparities across rural America. J Community Health. 2010;35:365–74.
pubmed: 20386968
doi: 10.1007/s10900-010-9259-0
Schillinger D, Barton LR, Karter AJ, Wang F, Adler N. Does literacy mediate the relationship between education and health outcomes? A study of a low-income population with diabetes. Public Health Rep. 2006;121(3):245–54.
pubmed: 16640146
pmcid: 1525295
doi: 10.1177/003335490612100305
Madden JM, Graves AJ, Ross-Degnan D, Briesacher BA, Soumerai SB. Cost-related medication nonadherence after implementation of Medicare Part D, 2006–2007. JAMA: J Am Med Association. 2009;302(16):1755.
doi: 10.1001/jama.2009.1516
McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Health of previously uninsured adults after acquiring Medicare coverage. JAMA. 2007;298(24):2886–94.
pubmed: 18159058
doi: 10.1001/jama.298.24.2886
Mutyambizi C, Booysen F, Stokes A, Pavlova M, Groot W. Lifestyle and socio-economic inequalities in diabetes prevalence in South Africa: a decomposition analysis. PLoS ONE. 2019;14(1):e0211208.
pubmed: 30699173
pmcid: 6353159
doi: 10.1371/journal.pone.0211208
De Silva AP, De Silva SHP, Haniffa R, Liyanage IK, Jayasinghe S, Katulanda P, et al. Inequalities in the prevalence of diabetes mellitus and its risk factors in Sri Lanka: a lower middle income country. Int J Equity Health. 2018;17:1–10.
doi: 10.1186/s12939-018-0759-3
Shera A, Jawad F, Maqsood A. Prevalence of diabetes in Pakistan. Diabetes Res Clin Pract. 2007;76(2):219–22.
pubmed: 17005289
doi: 10.1016/j.diabres.2006.08.011
Xu Y, Wang L, He J, Bi Y, Li M, Wang T, et al. Prevalence and control of diabetes in Chinese adults. JAMA. 2013;310(9):948–59.
pubmed: 24002281
doi: 10.1001/jama.2013.168118
Gnavi R, Petrelli A, Demaria M, Spadea T, Carta Q, Costa G. Mortality and educational level among diabetic and non-diabetic population in the Turin Longitudinal Study: a 9-year follow-up. Int J Epidemiol. 2004;33(4):864–71.
pubmed: 15131089
doi: 10.1093/ije/dyh089
Jacobs E, Tönnies T, Rathmann W, Brinks R, Hoyer A. Association between regional deprivation and type 2 diabetes incidence in Germany. BMJ Open Diabetes Res Care. 2019;7(1):e000857.
pubmed: 31908802
pmcid: 6936410
doi: 10.1136/bmjdrc-2019-000857