发展中国家糖尿病的患病率差异比较及其与体质量和初级卫生保健的关系研究  

Global Variability in Diabetes Mellitus and Its Association with Body Weight and Primary Healthcare Support in 49 Low-and Middle-Income Developing Countries

作　　者：刘隆健[1] 杨晓虹[2] 殷晓燕 Susan Morrissey 邹强[2] 杨书[2] 李茂全[2] 陈卫中[2] 

机构地区：[1]德雷塞尔大学公共卫生学院 [2]成都医学院公共卫生系,成都610083 [3]宾西法尼亚大学医学院内分泌科

出　　处：《成都医学院学报》2013年第2期114-121,共8页Journal of Chengdu Medical College

基　　金：WHO基金项目(NO:1-HC-95168)

摘　　要：目的利用世界卫生组织调查的数据,分析49个发展中国家糖尿病的患病率变化及其与体质量和初级卫生保健之间的联系。方法本研究中,糖尿病的界定是利用内科医生关于糖尿病诊断的个体报告;体质量指数(BMI)的计算是体质量(Kg)与身高平方(m2)的比值;治疗状态是评估是否获得卫生保健支持临床治疗以及糖尿病病人是否遵医并有行为改变;糖尿病和BMI以及治疗状态的关联使用横断面分析。结果共纳入215 898位个体进行研究。糖尿病年龄调整患病率范围从0.27%(马里)到15.54%(毛里求斯)。低体质量人群(BMI<18.5kg/m2),超体质量人群(BMI 25～29.9kg/m2)以及肥胖人群(BMI≥30kg/m2)患糖尿病的风险与正常体质量人群(BMI 18.5～24.9kg/m2)相比,差异具有统计学意义,多因素校正的OR值(95%CI)分别为1.15(1.07～1.24),1.56(1.44～1.68)和2.38(2.17～2.61)。所有纳入研究者中糖尿病患者的未治疗率为9.6%,低体质量患者的未治疗率最高,依次为正常体质量患者、超体质量患者、肥胖患者。结论在中低收入国家中,糖尿病的患病率变化以及糖尿病的初级卫生保健支持度的变化具有统计学意义。积极地预防人群超体质量和提高卫生保健支持度对于在发展中国家改善糖尿病的高流行可以发挥非常重要作用。Objective In the absence of any previous global comparison, we examined the variability in prevalence of diabetes mellitus across 49 developing countries, and the associations of diabetes with body weight and primary healthcare support using data from the World Health Survey. Methods Diabetes mellitus was defined by individuals＇self-report of a physician diagnosis of diabetes. BMI is the weight （kg）/the square of the height （m）. Healthcare support was assessed using clinical treatment status and whether patients with diabetes followed prescribed behaviour changes to control diabetes. Associations of diabetes with BMI and diabetes treatment status were analyzed cross-sectionally. Results A total of 215 898 participants were included in the analysis. Age adjusted prevalence of diabetes ranged from 0.27% （Mall）to 15.54% （Mauritius）. Participants who were underweight（BMI〈 18.5 kg/㎡） ,overweight（BMI 25 29.9 kg/㎡） and obe^e（BMI≥30 kg/㎡） were significantly associated with odds of having diabetes as compared with those who were of normal weight（BMI 18.5 24.9 kg/㎡）, with corresponding values of multivariate adjusted odds ratios（95%CI）of 1. 15（1.07-1.24）, 1.56（1.44 -1.68）and 2.38（2. 17-2.61）, respectively. The overall untreated rate of those with diabetes mellitus was 9.6 % in the total sample. Patients with underweight had the highest diabetes untreated rate, followed by those with normal weight, overweight and obesity.Conclusion There are significant variations in prevalence of diabetes and primary heahhcare support for diabetes across low-and middle-income countries. Aggressively preventing abnormal body weight and improving healthcare support may play a pivotal role in ameliorating the unfavorable epidemic of diabetes in developing countries.

关 键 词：体质量 糖尿病 全球变化 卫生保健支持 

分 类 号：R587.1[医药卫生—内分泌]